Knowledge, Attitude, and Readiness of Pharmacists in Iraq toward Medication Therapy Management for Patients with Attention Deficit Hyperactivity Disorder: A Cross-sectional Study

Knowledge, Attitude, and Readiness of Pharmacists in Iraq toward Medication Therapy Management for Patients with Attention Deficit Hyperactivity Disorder: A Cross-sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Knowledge, Attitude, and Readiness of Pharmacists in Iraq toward Medication Therapy Management for Patients with Attention Deficit Hyperactivity Disorder: A Cross-sectional Study Zahraa Al-Dujaili, Souheil Hallit, Achraf Al Faraj This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2608007/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 11 Sep, 2023 Read the published version in International Journal of Clinical Pharmacy → Version 1 posted 4 You are reading this latest preprint version Abstract Background Medication Therapy Management (MTM) is a patient-centered, collaborative service that optimizes drug therapy and improves clinical outcomes, including quality of life. Pharmacists play a critical role in MTM service and are uniquely positioned to provide comprehensive medication management for patients with attention deficit hyperactivity disorder (ADHD). Aim The aim of this study was to assess the knowledge, attitude, and readiness of Iraqi pharmacists regarding MTM service in general and medication management of ADHD patients. Method A cross-sectional study was conducted among 480 Iraqi pharmacists working in community pharmacies in Baghdad. Data were collected using a pre-validated 34-item self-administered questionnaire. Results Results showed that only 26.5% of pharmacists had good knowledge, 30.4% had good attitude, and 30.8% had high readiness regarding MTM service and ADHD medication management. Multivariate analyses revealed that a higher number of hours worked per week in the hospital was significantly associated with a lower likelihood of a high attitude, whereas experience with MTM, high knowledge, and high attitude were significantly associated with a higher likelihood of high readiness. Conclusion The findings of this study indicate that knowledge, attitudes, and readiness regarding MTM service and ADHD medication management are inadequate. Therefore, there is an urgent need for effective educational strategies to better prepare pharmacists for their potential role in the community, particularly for the provision of MTM service and ADHD care. In this way, pharmacists can better assist patients in managing their medications, improve clinical outcomes and ultimately increase the efficiency of the overall health care system. Clinical Pharmacy Medication Therapy Management Attention Deficit Hyperactivity Disorder Mental Health Community Pharmacists Impact Of Findings On Practice Statements The study reveals that Iraqi community pharmacists have inadequate knowledge, attitudes, and readiness regarding MTM service and ADHD medication management, which raises concerns about the quality of patient care. The research highlights the urgent need for effective educational strategies to equip pharmacists with the knowledge and skills to provide comprehensive medication management to patients with ADHD, emphasizing the importance of clinical guidelines in this process. Continuing education on current clinical guidelines could be an effective approach to address the knowledge gap and equip pharmacists with the knowledge they need to provide high-quality patient care. Standardization of pharmacist curricula related to therapeutic areas and emphasize on the importance of clinical guidelines may be necessary to better prepare pharmacists for a broader spectrum of patient care. Introduction Medication Therapy Management (MTM) is a patient-centered, mainly pharmacist-led, collaborative service that aims to optimize drug therapy, improve clinical outcomes, and enhance quality of life [ 1 ]. MTM is on the rise worldwide; over the past decade, MTM adoption has increased in the United States, and the Medicare Modernization Act highlights the importance of using MTM service to achieve three distinct goals: Improving patient adherence, effectively informing and counseling patients about their drug therapy, and detecting therapy-related adverse drug events [ 2 ]. The Centers for Disease Control and Prevention has presented compelling evidence of the effectiveness of MTM programs delivered by pharmacists that include a drug therapy review, personal medication record, medication-related action plan, intervention or referral, and documentation and follow-up [ 3 , 4 ]. The MTM service is an all-encompassing and comprehensive service that can be adapted to a variety of setting, including primary care, outpatient clinics, patient residences, corporate health programs, senior centers, hospitals, and community pharmacies [ 5 ]. Collaboration between pharmacists, physicians, and other health care providers is necessary to achieve the goal of MTM [ 4 ]. The American Pharmacist Association refers to MTM as pharmaceutical care in which a team of caregivers collaborates to achieve a primary goal, such as preventing disease and determining the safety and effectiveness of a drug therapy regimen [ 2 ]. Compared with conventional care, MTM service significantly improved treatment and safety outcomes. Patients’ treatment plans were optimized to reduce the risk of adverse events [ 6 ]. A previous observational study found that drug-drug interactions, therapeutic duplications, and incorrect prescribing instructions decreased after using pharmacy-led MTM service [ 7 ]. In addition, research has shown that patients' clinical, economic, and humanitarian outcomes improved when they received MTM service from pharmacists [ 8 , 9 ]. The pharmacist role is evolving from medication dispensing to a clinically oriented role that provides medication therapy management leading to improved health and disease prevention [ 2 ]. Pharmacy-led MTM service will help pharmacists leverage their clinical expertise and knowledge to improve health care and achieve better clinical outcomes. As a result, the pharmacy profession may evolve in new directions [ 10 , 11 ]. Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by impairments in inattention, disorganization, and/or hyperactivity/impulsivity according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [ 12 ]. ADHD begins in childhood and can persist during adulthood. It is estimated that 5–9% of children and adolescents and 3–5% of adults worldwide have ADHD [ 13 ]. ADHD is associated with negative outcomes and poorer quality of life, including poorer academic performance and social rejection in children and higher unemployment rates in adults, higher risk of crime, and substance abuse. The short-term efficacy of pharmacological treatments is well documented, but there is less certainty about their long-term effectiveness. Further studies are needed to determine whether behavioral therapies are effective in treating ADHD [ 14 ]. Psychostimulants and non-psychostimulants remain the cornerstone of ADHD treatment and have been shown to have a significant impact on reducing symptoms. The potential for adverse effects, misuse, and diversion of ADHD medications requires prudent therapeutic monitoring. Effective treatment is necessary to achieve full functioning in social, educational, and family settings. Individualized treatment plans that work with the medical and educational caregivers of children with ADHD can improve children's quality of life [ 15 ]. Many children discontinue ADHD medication treatment within the first year due to psychological side effects or inadequate medication efficacy. Therefore, pharmacists have an important and unique position in that they can positively influence ADHD treatment outcomes [ 16 ]. Pharmacists are knowledgeable about the properties and prescribing of controlled substances. In addition, they are the gatekeepers to MTM, where they can use their clinical knowledge of drug formulations and pharmacokinetic profiles of stimulants to optimize treatment. A recent study described the successful implementation and partnership of a collaborative agreement between pharmacists and psychiatrists. Pharmacist involvement included psychiatric assessment, medication management, counseling, and referral to support service [ 17 ]. To provide accurate and up-to-date patient counseling, pharmacists must have an adequate understanding of the disease's state and its treatment. By taking advantage of continuing education opportunities, they can develop professionally and work effectively and efficiently [ 18 ]. Consequently, pharmaceutical care focuses on the pharmacist's knowledge, attitudes, behaviors, commitments, concerns, ethics, responsibilities, and skills to achieve the stated goal of MTM [ 19 ]. Several studies suggest that pharmacists are among the gatekeepers providing pharmacy-led MTM service [ 20 , 21 ]. Although MTM can be applied in a variety of clinical settings, community pharmacies are an ideal setting where pharmacists have the opportunity to interact more frequently with their patients [ 22 ]. MTM differs from patient counseling in that it is conducted independently of medication dispensing and involves collaboration with patients and providers [ 23 ]. However, there are limited data assessing pharmacists' knowledge, attitude, and readiness for MTM service in several countries including Iraq. Aim The aim of this study was to assess the knowledge, attitude, and readiness of Iraqi community pharmacists regarding MTM for ADHD patients. Ethics Approval To conduct this cross-sectional study, the research design was reviewed and approved by the AUIB Institutional Review Board (IRB) committee (reference number: 2022-002A). To prevent possible identification of participants, responses were completely anonymous, and no personal information was collected. Participants provided informed consent to participate in this survey. Methods Study subject and setting A sample of 480 registered pharmacists was included in the study. Inclusion criteria included pharmacists who were licensed by the Syndicate of Iraqi Pharmacists and authorized to practice pharmacy in Iraq, were at least 22 years old, and agreed to participate in the study. A group of 10 pharmacy students volunteering for the Scientific Society of the College of Pharmacy at the American University of Iraq - Baghdad (AUIB) visited independent chain pharmacies in Baghdad, the capital of Iraq, between December 2022 and January 2023, briefly introduced the aim of the study, and asked Iraqi community pharmacists to complete the self-administered anonymous questionnaire without receiving any compensation. Before participating in the survey, participants were asked to provide informed consent, and after receiving it, they were directed to the questionnaire. Microsoft Forms was used for the electronic survey. The questionnaire was written in English and translated into Arabic. Pharmacists were given unlimited time to respond but were not allowed to communicate with other pharmacists. Measures An observational cross-sectional study, consisting of 34 questions divided into four sections that capture sociodemographic data, knowledge, attitudes, and readiness to provide MTM service and ADHD medication management. The seven questions on pharmacists' knowledge of MTM service and ADHD medication management were adapted from previous validated questionnaires [ 13 , 19 , 24 ]. A 5-point Likert scale was used for responses to the knowledge domains, which included either (not at all) 1–5 (to a great extent) or (1 = poor; 2 = fairly; good; 3 = very good; 4 = excellent) (Cronbach’s alpha in this study = 0.90). In addition, seven questions regarding pharmacists' attitudes toward MTM service and ADHD medication management were adapted from previous validated questionnaires [ 13 , 25 ]. A 5-point Likert scale was used for responses to the attitudinal domains, which included the following responses: 1 = strongly disagree; 2 = disagree; 3 = neutral; 4 = agree; 5 = strongly agree (Cronbach’s alpha in this study = 0.84). The six questions regarding pharmacists' readiness for MTM service and ADHD medication management were adapted from previous validated questionnaires [ 19 , 24 , 26 ]. The final six questions consisted of a 5-point Likert scale that included the following values for the responses to the readiness domains: 1 = strongly disagree; 2 = disagree; 3 = neutral; 4 = agree; 5 = strongly agree and a multiple-choice question (Cronbach’s alpha in this study = 0.65). The list of survey questions is attached as supplemental material. The questionnaires used in this study were reviewed by five experts in the field of clinical pharmacy for additional content validity and relevance. Based on the insightful findings of the experts, the final questionnaire was revised and confirmed. Finally, a pilot study was conducted with ten pharmacists to test its reliability. The pharmacists who participated in the pilot study were not included in the final analysis. Data analysis Results were analyzed using the Statistical Package for the Social Science (SPSS®) version 25.0 (IBM Corp., Armonk, N.Y., USA). Cronbach’s alpha was calculated for reliability analysis. The knowledge, attitude and readiness scores were dichotomized into low/high according to the 75th percentile. The Chi-square test was used to compare two categories, whereas the student’s t-test was used to compare two means. Three logistic regressions were conducted taking each score as the dependent variable respectively. Factors that showed a p < 0.25 in the bivariate analysis were entered as independent variables in the final model. p < 0.05 was considered statistically significant. Results Sociodemographic information A total of 480 community pharmacists enrolled in this study. The sociodemographic characteristics of the participants are shown in Table 1 . The mean age was 28.76 ± 6.35 years, and participants were male (n = 248, 51.7%). Most of the participating pharmacists had a bachelor's degree (n = 423, 88.1%). Participants with the highest degree were from Iraq (n = 390, 81.13%) and participants with a degree from Iraq had graduated from a public university (n = 199, 51.0%). The mean work experience as a community pharmacist was 5.36 ± 5.92 years and participants worked 26.23 ± 48.53 hours per week in the hospital. Of the respondents, (n = 203, 42.3%) frequently served more than one customer at a time and 48.14 ± 48.53 customers per day. Table 1 Sociodemographic and other characteristics of the participants (n = 480) n (%) Gender Male 248 (51.7%) Female 232 (48.3%) Highest degree Bachelor 423 (88.1%) PharmD 16 (3.3%) Master 30 (6.3%) PhD 11 (2.3%) Highest degree from Iraq No 90 (18.8%) Yes 390 (81.3%) Type of university Public 199 (51.0%) Private 191 (49.0%) Additional diploma No 455 (94.8%) Yes 25 (5.2%) Serve more than one customer at one time Always 162 (33.8%) Frequently 203 (42.3%) Rarely 86 (17.9%) Never 29 (6.0%) Computer literacy Poor 27 (5.6%) Fair 72 (15.0%) Good 256 (53.3%) Very good 98 (20.4%) Excellent 27 (5.6%) Practice MTM No 241 (50.2%) Yes 239 (49.8%) Mean ± SD Age (in years) 28.76 ± 6.35 Years of experience 5.36 ± 5.92 Number of customers served per day 48.14 ± 48.53 Number of hours of work at the hospital 26.23 ± 24.31 Knowledge, attitude, and readiness of Iraqi pharmacists in MTM service and ADHD medication management Seven different questions were used to assess pharmacists' knowledge and attitudes regarding MTM service and ADHD medication management. Six questions were used to assess pharmacists' readiness regarding MTM service and ADHD medication management. The result showed that only 127 (26.5%) pharmacists had good knowledge (scores ≥ 34, corresponding to the 75th percentile), only 146 (30.4%) had good attitude (scores ≥ 29), and finally only 148 (30.8%) had high readiness (scores ≥ 21). The descriptions of the individual items on knowledge, attitude, and readiness items are summarized in supplementary tables S1, S2, and S3. Bivariate analysis of factors associated with knowledge, attitude, and readiness The results of the bivariate analysis are summarized in Table 2 . A higher percentage of participants with high knowledge had good/very good/excellent computer literacy and had practiced MTM. A higher number of participants with a high attitude had good knowledge and had a lower mean number of weekly working hours in the hospital. A higher percentage of participants with high readiness graduated from a public university, had practiced MTM and had high knowledge and attitude respectively. Table 2 Bivariate analysis of factors associated with knowledge, attitude and readiness Knowledge p Attitude p Readiness p Low High Low High Low High Gender .126 .140 .616 Male 175 (70.6%) 73 (29.4%) 180 (72.6%) 68 (27.4%) 169 (68.1%) 79 (31.9%) Female 178 (76.7%) 54 (23.3%) 154 (66.4%) 78 (33.6%) 163 (70.3%) 69 (29.7%) Highest degree .292 .528 .235 Bachelor 316 (74.7%) 107 (25.3%) 296 (70.0%) 127 (30.0%) 294 (69.5%) 129 (30.5%) PharmD 9 (56.3%) 7 (43.8%) 9 (56.3%) 7 (43.8%) 9 (56.3%) 7 (43.8%) Master 20 (66.7%) 10 (33.3%) 20 (66.7%) 10 (33.3%) 19 (63.3%) 11 (36.7%) PhD 8 (72.7%) 3 (27.3%) 9 (81.8%) 2 (18.2%) 10 (90.9%) 1 (9.1%) Highest degree from Iraq .101 .680 .066 No 60 (66.7%) 30 (33.3%) 61 (67.8%) 29 (32.2%) 55 (61.1%) 35 (38.9%) Yes 293 (75.1%) 97 (24.9%) 273 (70.0%) 117 (30.0%) 277 (71.0%) 113 (29.0%) Type of university .413 .466 .037 Public 153 (76.9%) 46 (23.1%) 136 (68.3%) 63 (31.7%) 132 (66.3%) 67 (33.7%) Private 140 (73.3%) 51 (26.7%) 137 (71.7%) 54 (28.3%) 145 (75.9%) 46 (24.1%) Additional diploma .858 .787 .308 No 335 (73.6%) 120 (26.4%) 316 (69.5%) 139 (30.5%) 317 (69.7%) 138 (30.3%) Yes 18 (72.0%) 7 (28.0%) 18 (72.0%) 7 (28.0%) 15 (60.0%) 10 (40.0%) Serve more than one customer at one time .082 .802 .167 Always 111 (68.5%) 51 (31.5%) 113 (69.8%) 49 (30.2%) 102 (63.0%) 60 (37.0%) Frequently 149 (73.4%) 54 (26.6%) 145 (71.4%) 58 (28.6%) 145 (71.4%) 58 (28.6%) Rarely 72 (83.7%) 14 (16.3%) 57 (66.3%) 29 (33.7%) 65 (75.6%) 21 (24.4%) Never 21 (72.4%) 8 (27.6%) 19 (65.5%) 10 (34.5%) 20 (69.0%) 9 (31.0%) Computer literacy .001 .643 .389 Poor/Fair 86 (86.9%) 13 (13.1%) 67 (67.7%) 32 (32.3%) 72 (72.7%) 27 (27.3%) Good/ Very good/ Excellent 267 (70.1%) 114 (29.9%) 267 (70.1%) 114 (29.9%) 260 (68.2%) 121 (31.8%) Practice MTM < .001 .736 .015 No 197 (81.7%) 44 (18.3%) 166 (68.9%) 75 (31.1%) 179 (74.3%) 62 (25.7%) Yes 156 (65.3%) 83 (34.7%) 168 (70.3%) 71 (29.7%) 153 (64.0%) 86 (36.0%) Knowledge .011 < .001 Low 257 (72.8%) 96 (27.2%) 269 (76.2%) 84 (23.8%) High 77 (60.6%) 50 (39.4%) 63 (49.6%) 64 (50.4%) Attitude < .001 Low 270 (80.8%) 64 (19.2%) High 62 (42.5%) 84 (57.5%) Age 28.84 ± 6.66 28.54 ± 5.39 .645 28.66 ± 6.46 28.99 ± 6.08 .603 28.58 ± 6.51 29.16 ± 5.97 .352 Years of experience 5.47 ± 6.31 5.06 ± 4.66 .447 5.27 ± 5.91 5.56 ± 5.94 .624 5.31 ± 6.10 5.49 ± 5.51 .758 Number of customers served/day 44.86 ± 45.74 57.32 ± 54.76 .023 47.65 ± 49.19 49.26 ± 47.13 .740 46.51 ± 48.28 51.82 ± 49.06 .270 Number of hours of work at the hospital 24.97 ± 23.84 29.72 ± 25.35 .059 28.01 ± 25.49 22.16 ± 20.91 .009 26.57 ± 24.64 25.47 ± 23.63 .646 Multivariable analysis The results of the multivariable analysis are summarized in Table 3 . Serving more than one customer at a time rarely compared to always (aOR = .48) was significantly associated with lower odds of having high knowledge, whereas having good/very good/excellent computer literacy compared to poor/fair) (aOR = 2.38) and having practiced MTM (aOR = 2.24) were significantly associated with higher odds of having high knowledge (Table 3 , Model 1). Table 3 Multivariable analyses. aOR p 95% CI Model 1: Logistic regression taking the dichotomous knowledge score (high vs low*) as the dependent variable (R 2 = .110) Highest degree from Iraq (yes vs no*) .77 .320 .46; 1.29 Serve more than one customer at one time .133 Always 1 Frequently .91 .687 .56; 1.46 Rarely .48 .034 .24; .95 Never 1.32 .563 .52; 3.33 Computer literacy (good/very good/excellent vs poor/fair*) 2.38 .008 1.25; 4.52 Practiced MTM (yes vs no*) 2.24 < .001 1.44; 3.46 Hours per week working in the hospital 1.00 .166 .99; 1.01 Model 2: Logistic regression taking the dichotomous attitude score (high vs low*) as the dependent variable (R 2 = .048) Gender (females vs males*) 1.40 .096 .94; 2.09 Working hours per week in the hospital .988 .008 .979; .997 Knowledge (high vs low*) 1.91 .004 1.24; 2.96 Model 3: Logistic regression taking the dichotomous practice score (high vs low*) as the dependent variable (R 2 = .274) Highest degree .996 Bachelor 1 PharmD .92 .895 .25; 3.39 Master 1.11 .842 .39; 3.19 PhD .001 .999 .0001; .000 Type of university (private vs public*) .58 .037 .35; .97 Serve more than one customer at one time .354 Always 1 Frequently .62 .095 .35; 1.09 Rarely .63 .211 .30; 1.30 Never .84 .747 .29; 2.46 Practiced MTM (yes vs no*) 1.79 .027 1.07; 2.98 Knowledge (high vs low*) 2.91 < .001 1.68; 5.04 Attitude (high vs low*) 5.09 < .001 3.04; 8.52 A higher number of working hours per week in the hospital (aOR = .988) was significantly associated with lower odds of having high attitude, whereas having high knowledge (aOR = 1.91) was significantly associated with higher odds of having high attitude (Table 3 , Model 2). Having studied in a private university compared to public (aOR = .58) was significantly associated with lower odds of having high readiness, whereas having practiced MTM (aOR = 1.79), high knowledge (aOR = 2.91) and high attitude (aOR = 5.09) were significantly associated with higher odds of having high readiness (Table 3 , Model 3). Discussion Key findings To our best knowledge, this is the first study to examine Iraqi pharmacists' knowledge of MTM and ADHD. The study reveals that Iraqi community pharmacists have inadequate knowledge, attitudes, and readiness regarding MTM service and ADHD medication management, leading to concerns about the quality of patient care. In addition, this study raises concerns that young pharmacists, who should be up to date in the community, need adequate training in MTM and ADHD. Educating pharmacists on MTM and ADHD through continuing education modules should be a priority and would fill knowledge gaps among pharmacists. There may also be a need to improve and standardize curricula for Iraqi pharmacists and emphasize the importance of clinical guidelines and direct the pharmacy profession toward more effective patient care. Interpretation Compared with a recent cross-sectional study in Canada in which pharmacists reported their knowledge of ADHD treatment, self-assessed ADHD knowledge was 5.8 ± 1.96 on a 10-point scale. This result also suggests the importance of additional ADHD training for pharmacists in Canada [ 13 ]. In a previous U.S. study, pharmacists in Arizona who had no psychiatric training or experience indicated that one of the difficulties in administering psychotropic medications to patients was their lack of knowledge about psychiatric disorders [ 26 ]. Compared with a recent similar study in a neighboring country, Jordan showed a moderate level of knowledge and a positive attitude of pharmacists towards MTM service. The study pointed out the lack of training on MTM care and appropriate support staff [ 25 ]. The results of our study differed from the study in Malaysia, where pharmacists showed a high level of knowledge and positive attitude toward MTM service. In terms of practice, most pharmacists indicated that they would be willing to become MTM service providers in the future [ 24 ]. Multivariable analysis revealed that serving more than one customer at a time was less likely to be associated with a high level of knowledge. One explanation for this finding is that Iraqi pharmacists generally do not have many patients with whom to apply their knowledge. On the other hand, MTM service require appropriate settings such as workflow, time, and staff to deliver the service, including reviewing patients' medication profiles and providing interventions [ 19 ]. In addition, having good/very good/excellent computer skills (compared with poor/fair) and having practiced MTM were significantly associated with a higher likelihood of having a high level of knowledge. This could be due to the fact that individuals who had practiced MTM were more motivated to learn more about it, resulting in higher knowledge levels. Working longer hours per week in the hospital was significantly associated with a lower likelihood of having a high attitude. However, working conditions, high workload, and stress-related factors in the hospital could contribute to low attitudes toward MTM service performance. A recent Lebanese study showed that adequate workflow, time, and staffing were positively and statistically associated with willingness to perform MTM and active participation in MTM [ 19 ]. However, a high level of knowledge was significantly associated with a higher likelihood of a high attitude. This suggests that high knowledge levels are more likely to lead to positive attitudes toward the provision of MTM services in Iraqi pharmacies. In addition, studying at a private university was significantly associated with a lower likelihood of having a high attitude than studying at a public university. Several factors could be at play here, such as differences in the quality of education, the availability of resources, or the demographic composition of students at private and public universities. Finally, high knowledge and attitudes about MTM were significantly associated with a higher likelihood of having high readiness. In other words, a better understanding of MTM can lead to more positive attitudes toward MTM, and the likelihood of having high readiness is higher than having less knowledge or less positive attitudes toward MTM. Weaknesses A weakness of the present study was that the results may not be representative of the entire pharmacy sector in Iraq. However, Baghdad is the capital of Iraq with an expectedly high density of pharmacists. Pharmacists in Baghdad are likely to be the pioneers who will bring about important changes in pharmacy practice in Iraq. In addition, responses were collected using a self-report questionnaire, which could introduce bias into the information. Reliability analysis of the readiness scale was low. The convenient sampling method used to recruit participants and the unknown refusal rate could lead to selection bias. Further research In this context, a future survey could be conducted to obtain feedback from pharmacists on the possibility of establishing an MTM service in the clinical setting in Iraq, specialized in different therapeutic areas and provided by Iraqi pharmacists. The future establishment of MTM services in Iraq specializing in different therapeutic areas and provided by Iraqi pharmacists could improve patient care and potentially enhance the role of pharmacists in communities and would provide a special opportunity for Iraqi pharmacists to participate in a broader range of patient care. Conclusion Our findings indicate that Iraqi pharmacists' knowledge, attitude, and readiness regarding MTM service and ADHD medication management are inadequate. This study highlights the urgent need for effective educational strategies that should better prepare pharmacists for their potential roles in community, MTM service, and ADHD care. Continuing education on current clinical guidelines could be an effective approach to address the knowledge gap. It may be necessary to improve and standardize pharmacist curricula related to therapeutic areas and emphasize the importance of clinical guidelines to equip pharmacists with the knowledge they need to provide quality patient care and engage in a broader spectrum of patient care. Declarations Acknowledgements The authors gratefully acknowledge the contribution of pharmacy students of the Scientific Society of the College of Pharmacy at the American University of Iraq - Baghdad (AUIB) for their valuable help in visiting 480 community pharmacies in Baghdad, the capital of Iraq, to collect the data. The authors would also like to thank all the participating pharmacists who spent their valuable time to complete the questionnaire. Funding: The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. Competing Interests: The authors have no relevant financial or non-financial interests to disclose. Author Contributions: All authors contributed to the conception and design of the study. Preparation of the material and data collection were led by Zahraa Al-Dujaili and Achraf Al Faraj, while data analysis was conducted by Souheil Hallit. The first draft of the manuscript was written by Zahraa Al-Dujaili, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Data Availability: The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request. References Marupuru S, Roether A, Guimond AJ, et al. A Systematic Review of Clinical Outcomes from Pharmacist Provided Medication Therapy Management (MTM) among Patients with Diabetes, Hypertension, or Dyslipidemia. Healthcare. 2022;10:1207. Ferreri SP, Hughes TD, Snyder ME. Medication Therapy Management: Current Challenges. Integr Pharm Res Pract. 2020;Volume 9:71–81. Hohmeier KC, Wheeler JS, Turner K, et al. 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Supplementary Files SupplementaryTables.docx Cite Share Download PDF Status: Published Journal Publication published 11 Sep, 2023 Read the published version in International Journal of Clinical Pharmacy → Version 1 posted Reviewers agreed at journal 05 Mar, 2023 Editor invited by journal 23 Feb, 2023 Editor assigned by journal 23 Feb, 2023 First submitted to journal 20 Feb, 2023 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2608007","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":180513315,"identity":"48e60987-2d6e-48e4-8a8f-4949287a3fa1","order_by":0,"name":"Zahraa Al-Dujaili","email":"","orcid":"","institution":"American University of Iraq Baghdad","correspondingAuthor":false,"prefix":"","firstName":"Zahraa","middleName":"","lastName":"Al-Dujaili","suffix":""},{"id":180513316,"identity":"57c345f4-04f7-44c4-ac84-73bc630119a7","order_by":1,"name":"Souheil Hallit","email":"","orcid":"","institution":"Holy Spirit University of Kaslik: Universite Saint-Esprit de Kaslik","correspondingAuthor":false,"prefix":"","firstName":"Souheil","middleName":"","lastName":"Hallit","suffix":""},{"id":180513317,"identity":"6cf3b33c-addf-44c0-afed-6dd4f47a9758","order_by":2,"name":"Achraf Al Faraj","email":"data:image/png;base64,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","orcid":"https://orcid.org/0000-0002-8943-1354","institution":"American University of Iraq Baghdad","correspondingAuthor":true,"prefix":"","firstName":"Achraf","middleName":"Al","lastName":"Faraj","suffix":""}],"badges":[],"createdAt":"2023-02-20 12:52:24","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2608007/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2608007/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s11096-023-01628-3","type":"published","date":"2023-09-11T15:02:09+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":43301189,"identity":"b8e83dd0-1389-46f5-bb2b-373d18ef92a6","added_by":"auto","created_at":"2023-09-18 15:08:55","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":491814,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2608007/v1/e85a7a0c-2578-4537-8ac6-9519ac576cd5.pdf"},{"id":33918242,"identity":"fae489cc-b28d-4608-9fd3-5cc0b5b29bb9","added_by":"auto","created_at":"2023-03-07 18:14:26","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":18258,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryTables.docx","url":"https://assets-eu.researchsquare.com/files/rs-2608007/v1/b480709d6fd2cadd5a692021.docx"}],"financialInterests":"","formattedTitle":"Knowledge, Attitude, and Readiness of Pharmacists in Iraq toward Medication Therapy Management for Patients with Attention Deficit Hyperactivity Disorder: A Cross-sectional Study","fulltext":[{"header":"Impact Of Findings On Practice Statements","content":"\u003cul\u003e\n \u003cli\u003eThe study reveals that Iraqi community pharmacists have inadequate knowledge, attitudes, and readiness regarding MTM service and ADHD medication management, which raises concerns about the quality of patient care.\u003c/li\u003e\n \u003cli\u003eThe research highlights the urgent need for effective educational strategies to equip pharmacists with the knowledge and skills to provide comprehensive medication management to patients with ADHD, emphasizing the importance of clinical guidelines in this process.\u003c/li\u003e\n \u003cli\u003eContinuing education on current clinical guidelines could be an effective approach to address the knowledge gap and equip pharmacists with the knowledge they need to provide high-quality patient care.\u003c/li\u003e\n \u003cli\u003eStandardization of pharmacist curricula related to therapeutic areas and emphasize on the importance of clinical guidelines may be necessary to better prepare pharmacists for a broader spectrum of patient care.\u003cbr\u003e\u0026nbsp;\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Introduction","content":"\u003cp\u003eMedication Therapy Management (MTM) is a patient-centered, mainly pharmacist-led, collaborative service that aims to optimize drug therapy, improve clinical outcomes, and enhance quality of life [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. MTM is on the rise worldwide; over the past decade, MTM adoption has increased in the United States, and the Medicare Modernization Act highlights the importance of using MTM service to achieve three distinct goals: Improving patient adherence, effectively informing and counseling patients about their drug therapy, and detecting therapy-related adverse drug events [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The Centers for Disease Control and Prevention has presented compelling evidence of the effectiveness of MTM programs delivered by pharmacists that include a drug therapy review, personal medication record, medication-related action plan, intervention or referral, and documentation and follow-up [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The MTM service is an all-encompassing and comprehensive service that can be adapted to a variety of setting, including primary care, outpatient clinics, patient residences, corporate health programs, senior centers, hospitals, and community pharmacies [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Collaboration between pharmacists, physicians, and other health care providers is necessary to achieve the goal of MTM [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The American Pharmacist Association refers to MTM as pharmaceutical care in which a team of caregivers collaborates to achieve a primary goal, such as preventing disease and determining the safety and effectiveness of a drug therapy regimen [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Compared with conventional care, MTM service significantly improved treatment and safety outcomes. Patients\u0026rsquo; treatment plans were optimized to reduce the risk of adverse events [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. A previous observational study found that drug-drug interactions, therapeutic duplications, and incorrect prescribing instructions decreased after using pharmacy-led MTM service [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In addition, research has shown that patients' clinical, economic, and humanitarian outcomes improved when they received MTM service from pharmacists [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The pharmacist role is evolving from medication dispensing to a clinically oriented role that provides medication therapy management leading to improved health and disease prevention [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Pharmacy-led MTM service will help pharmacists leverage their clinical expertise and knowledge to improve health care and achieve better clinical outcomes. As a result, the pharmacy profession may evolve in new directions [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAttention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by impairments in inattention, disorganization, and/or hyperactivity/impulsivity according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. ADHD begins in childhood and can persist during adulthood. It is estimated that 5\u0026ndash;9% of children and adolescents and 3\u0026ndash;5% of adults worldwide have ADHD [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. ADHD is associated with negative outcomes and poorer quality of life, including poorer academic performance and social rejection in children and higher unemployment rates in adults, higher risk of crime, and substance abuse. The short-term efficacy of pharmacological treatments is well documented, but there is less certainty about their long-term effectiveness. Further studies are needed to determine whether behavioral therapies are effective in treating ADHD [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Psychostimulants and non-psychostimulants remain the cornerstone of ADHD treatment and have been shown to have a significant impact on reducing symptoms. The potential for adverse effects, misuse, and diversion of ADHD medications requires prudent therapeutic monitoring. Effective treatment is necessary to achieve full functioning in social, educational, and family settings. Individualized treatment plans that work with the medical and educational caregivers of children with ADHD can improve children's quality of life [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Many children discontinue ADHD medication treatment within the first year due to psychological side effects or inadequate medication efficacy. Therefore, pharmacists have an important and unique position in that they can positively influence ADHD treatment outcomes [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Pharmacists are knowledgeable about the properties and prescribing of controlled substances. In addition, they are the gatekeepers to MTM, where they can use their clinical knowledge of drug formulations and pharmacokinetic profiles of stimulants to optimize treatment. A recent study described the successful implementation and partnership of a collaborative agreement between pharmacists and psychiatrists. Pharmacist involvement included psychiatric assessment, medication management, counseling, and referral to support service [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. To provide accurate and up-to-date patient counseling, pharmacists must have an adequate understanding of the disease's state and its treatment. By taking advantage of continuing education opportunities, they can develop professionally and work effectively and efficiently [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Consequently, pharmaceutical care focuses on the pharmacist's knowledge, attitudes, behaviors, commitments, concerns, ethics, responsibilities, and skills to achieve the stated goal of MTM [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Several studies suggest that pharmacists are among the gatekeepers providing pharmacy-led MTM service [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Although MTM can be applied in a variety of clinical settings, community pharmacies are an ideal setting where pharmacists have the opportunity to interact more frequently with their patients [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. MTM differs from patient counseling in that it is conducted independently of medication dispensing and involves collaboration with patients and providers [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. However, there are limited data assessing pharmacists' knowledge, attitude, and readiness for MTM service in several countries including Iraq.\u003c/p\u003e\n\u003ch3\u003eAim\u003c/h3\u003e\n\u003cp\u003eThe aim of this study was to assess the knowledge, attitude, and readiness of Iraqi community pharmacists regarding MTM for ADHD patients.\u003c/p\u003e\n\u003ch3\u003eEthics Approval\u003c/h3\u003e\n\u003cp\u003e To conduct this cross-sectional study, the research design was reviewed and approved by the AUIB Institutional Review Board (IRB) committee (reference number: 2022-002A). To prevent possible identification of participants, responses were completely anonymous, and no personal information was collected. Participants provided informed consent to participate in this survey.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eStudy subject and setting\u003c/p\u003e \u003cp\u003eA sample of 480 registered pharmacists was included in the study. Inclusion criteria included pharmacists who were licensed by the Syndicate of Iraqi Pharmacists and authorized to practice pharmacy in Iraq, were at least 22 years old, and agreed to participate in the study. A group of 10 pharmacy students volunteering for the Scientific Society of the College of Pharmacy at the American University of Iraq - Baghdad (AUIB) visited independent chain pharmacies in Baghdad, the capital of Iraq, between December 2022 and January 2023, briefly introduced the aim of the study, and asked Iraqi community pharmacists to complete the self-administered anonymous questionnaire without receiving any compensation. Before participating in the survey, participants were asked to provide informed consent, and after receiving it, they were directed to the questionnaire. Microsoft Forms was used for the electronic survey. The questionnaire was written in English and translated into Arabic. Pharmacists were given unlimited time to respond but were not allowed to communicate with other pharmacists.\u003c/p\u003e \u003cp\u003eMeasures\u003c/p\u003e \u003cp\u003eAn observational cross-sectional study, consisting of 34 questions divided into four sections that capture sociodemographic data, knowledge, attitudes, and readiness to provide MTM service and ADHD medication management. The seven questions on pharmacists' knowledge of MTM service and ADHD medication management were adapted from previous validated questionnaires [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. A 5-point Likert scale was used for responses to the knowledge domains, which included either (not at all) 1\u0026ndash;5 (to a great extent) or (1\u0026thinsp;=\u0026thinsp;poor; 2\u0026thinsp;=\u0026thinsp;fairly; good; 3\u0026thinsp;=\u0026thinsp;very good; 4\u0026thinsp;=\u0026thinsp;excellent) (Cronbach\u0026rsquo;s alpha in this study\u0026thinsp;=\u0026thinsp;0.90). In addition, seven questions regarding pharmacists' attitudes toward MTM service and ADHD medication management were adapted from previous validated questionnaires [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. A 5-point Likert scale was used for responses to the attitudinal domains, which included the following responses: 1\u0026thinsp;=\u0026thinsp;strongly disagree; 2\u0026thinsp;=\u0026thinsp;disagree; 3\u0026thinsp;=\u0026thinsp;neutral; 4\u0026thinsp;=\u0026thinsp;agree; 5\u0026thinsp;=\u0026thinsp;strongly agree (Cronbach\u0026rsquo;s alpha in this study\u0026thinsp;=\u0026thinsp;0.84). The six questions regarding pharmacists' readiness for MTM service and ADHD medication management were adapted from previous validated questionnaires [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. The final six questions consisted of a 5-point Likert scale that included the following values for the responses to the readiness domains: 1\u0026thinsp;=\u0026thinsp;strongly disagree; 2\u0026thinsp;=\u0026thinsp;disagree; 3\u0026thinsp;=\u0026thinsp;neutral; 4\u0026thinsp;=\u0026thinsp;agree; 5\u0026thinsp;=\u0026thinsp;strongly agree and a multiple-choice question (Cronbach\u0026rsquo;s alpha in this study\u0026thinsp;=\u0026thinsp;0.65). The list of survey questions is attached as supplemental material. The questionnaires used in this study were reviewed by five experts in the field of clinical pharmacy for additional content validity and relevance. Based on the insightful findings of the experts, the final questionnaire was revised and confirmed. Finally, a pilot study was conducted with ten pharmacists to test its reliability. The pharmacists who participated in the pilot study were not included in the final analysis.\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eResults were analyzed using the Statistical Package for the Social Science (SPSS\u0026reg;) version 25.0 (IBM Corp., Armonk, N.Y., USA). Cronbach\u0026rsquo;s alpha was calculated for reliability analysis. The knowledge, attitude and readiness scores were dichotomized into low/high according to the 75th percentile. The Chi-square test was used to compare two categories, whereas the student\u0026rsquo;s t-test was used to compare two means. Three logistic regressions were conducted taking each score as the dependent variable respectively. Factors that showed a \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.25 in the bivariate analysis were entered as independent variables in the final model. \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eSociodemographic information\u003c/p\u003e \u003cp\u003eA total of 480 community pharmacists enrolled in this study. The sociodemographic characteristics of the participants are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The mean age was 28.76\u0026thinsp;\u0026plusmn;\u0026thinsp;6.35 years, and participants were male (n\u0026thinsp;=\u0026thinsp;248, 51.7%). Most of the participating pharmacists had a bachelor's degree (n\u0026thinsp;=\u0026thinsp;423, 88.1%). Participants with the highest degree were from Iraq (n\u0026thinsp;=\u0026thinsp;390, 81.13%) and participants with a degree from Iraq had graduated from a public university (n\u0026thinsp;=\u0026thinsp;199, 51.0%). The mean work experience as a community pharmacist was 5.36\u0026thinsp;\u0026plusmn;\u0026thinsp;5.92 years and participants worked 26.23\u0026thinsp;\u0026plusmn;\u0026thinsp;48.53 hours per week in the hospital. Of the respondents, (n\u0026thinsp;=\u0026thinsp;203, 42.3%) frequently served more than one customer at a time and 48.14\u0026thinsp;\u0026plusmn;\u0026thinsp;48.53 customers per day.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic and other characteristics of the participants (n\u0026thinsp;=\u0026thinsp;480)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e248 (51.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e232 (48.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHighest degree\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBachelor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e423 (88.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePharmD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (3.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaster\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 (6.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (2.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHighest degree from Iraq\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e90 (18.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e390 (81.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eType of university\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePublic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e199 (51.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrivate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e191 (49.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAdditional diploma\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e455 (94.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25 (5.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eServe more than one customer at one time\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlways\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e162 (33.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFrequently\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e203 (42.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRarely\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e86 (17.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29 (6.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eComputer literacy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27 (5.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFair\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e72 (15.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e256 (53.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVery good\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e98 (20.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExcellent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27 (5.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePractice MTM\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e241 (50.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e239 (49.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (in years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28.76\u0026thinsp;\u0026plusmn;\u0026thinsp;6.35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYears of experience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.36\u0026thinsp;\u0026plusmn;\u0026thinsp;5.92\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of customers served per day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48.14\u0026thinsp;\u0026plusmn;\u0026thinsp;48.53\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of hours of work at the hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26.23\u0026thinsp;\u0026plusmn;\u0026thinsp;24.31\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eKnowledge, attitude, and readiness of Iraqi pharmacists in MTM service and ADHD medication management\u003c/p\u003e \u003cp\u003eSeven different questions were used to assess pharmacists' knowledge and attitudes regarding MTM service and ADHD medication management. Six questions were used to assess pharmacists' readiness regarding MTM service and ADHD medication management. The result showed that only 127 (26.5%) pharmacists had good knowledge (scores\u0026thinsp;\u0026ge;\u0026thinsp;34, corresponding to the 75th percentile), only 146 (30.4%) had good attitude (scores\u0026thinsp;\u0026ge;\u0026thinsp;29), and finally only 148 (30.8%) had high readiness (scores\u0026thinsp;\u0026ge;\u0026thinsp;21). The descriptions of the individual items on knowledge, attitude, and readiness items are summarized in supplementary tables S1, S2, and S3.\u003c/p\u003e \u003cp\u003eBivariate analysis of factors associated with knowledge, attitude, and readiness\u003c/p\u003e \u003cp\u003eThe results of the bivariate analysis are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. A higher percentage of participants with high knowledge had good/very good/excellent computer literacy and had practiced MTM. A higher number of participants with a high attitude had good knowledge and had a lower mean number of weekly working hours in the hospital. A higher percentage of participants with high readiness graduated from a public university, had practiced MTM and had high knowledge and attitude respectively.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e Bivariate analysis of factors associated with knowledge, attitude and readiness\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eKnowledge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eAttitude\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003eReadiness\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.126\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.140\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e.616\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e175 (70.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e73 (29.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e180 (72.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e68 (27.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e169 (68.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e79 (31.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e178 (76.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e54 (23.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e154 (66.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e78 (33.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e163 (70.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e69 (29.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHighest degree\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.292\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.528\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e.235\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBachelor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e316 (74.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e107 (25.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e296 (70.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e127 (30.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e294 (69.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e129 (30.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePharmD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9 (56.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7 (43.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e9 (56.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e7 (43.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e9 (56.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e7 (43.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaster\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20 (66.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10 (33.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e20 (66.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e10 (33.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e19 (63.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e11 (36.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8 (72.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (27.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e9 (81.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2 (18.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e10 (90.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e1 (9.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHighest degree from Iraq\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.680\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e.066\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e60 (66.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30 (33.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e61 (67.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e29 (32.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e55 (61.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e35 (38.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e293 (75.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e97 (24.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e273 (70.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e117 (30.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e277 (71.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e113 (29.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eType of university\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.413\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.466\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e.037\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePublic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e153 (76.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46 (23.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e136 (68.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e63 (31.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e132 (66.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e67 (33.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrivate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e140 (73.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e51 (26.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e137 (71.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e54 (28.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e145 (75.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e46 (24.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAdditional diploma\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.858\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.787\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e.308\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e335 (73.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e120 (26.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e316 (69.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e139 (30.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e317 (69.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e138 (30.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18 (72.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7 (28.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e18 (72.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e7 (28.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e15 (60.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e10 (40.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eServe more than one customer at one time\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.082\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.802\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e.167\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlways\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e111 (68.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e51 (31.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e113 (69.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e49 (30.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e102 (63.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e60 (37.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFrequently\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e149 (73.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e54 (26.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e145 (71.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e58 (28.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e145 (71.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e58 (28.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRarely\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e72 (83.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14 (16.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e57 (66.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e29 (33.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e65 (75.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e21 (24.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21 (72.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8 (27.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e19 (65.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e10 (34.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e20 (69.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e9 (31.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eComputer literacy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.643\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e.389\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoor/Fair\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e86 (86.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13 (13.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e67 (67.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e32 (32.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e72 (72.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e27 (27.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGood/ Very good/ Excellent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e267 (70.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e114 (29.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e267 (70.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e114 (29.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e260 (68.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e121 (31.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePractice MTM\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.736\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e.015\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e197 (81.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e44 (18.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e166 (68.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e75 (31.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e179 (74.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e62 (25.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e156 (65.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e83 (34.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e168 (70.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e71 (29.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e153 (64.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e86 (36.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eKnowledge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e.011\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e257 (72.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e96 (27.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e269 (76.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e84 (23.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e77 (60.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e50 (39.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e63 (49.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e64 (50.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAttitude\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e270 (80.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e64 (19.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e62 (42.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e84 (57.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28.84\u0026thinsp;\u0026plusmn;\u0026thinsp;6.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28.54\u0026thinsp;\u0026plusmn;\u0026thinsp;5.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.645\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e28.66\u0026thinsp;\u0026plusmn;\u0026thinsp;6.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e28.99\u0026thinsp;\u0026plusmn;\u0026thinsp;6.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.603\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e28.58\u0026thinsp;\u0026plusmn;\u0026thinsp;6.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e29.16\u0026thinsp;\u0026plusmn;\u0026thinsp;5.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e.352\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eYears of experience\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5.47\u0026thinsp;\u0026plusmn;\u0026thinsp;6.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.06\u0026thinsp;\u0026plusmn;\u0026thinsp;4.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.447\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5.27\u0026thinsp;\u0026plusmn;\u0026thinsp;5.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5.56\u0026thinsp;\u0026plusmn;\u0026thinsp;5.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.624\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e5.31\u0026thinsp;\u0026plusmn;\u0026thinsp;6.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e5.49\u0026thinsp;\u0026plusmn;\u0026thinsp;5.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e.758\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of customers served/day\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e44.86\u0026thinsp;\u0026plusmn;\u0026thinsp;45.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e57.32\u0026thinsp;\u0026plusmn;\u0026thinsp;54.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e.023\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e47.65\u0026thinsp;\u0026plusmn;\u0026thinsp;49.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e49.26\u0026thinsp;\u0026plusmn;\u0026thinsp;47.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.740\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e46.51\u0026thinsp;\u0026plusmn;\u0026thinsp;48.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e51.82\u0026thinsp;\u0026plusmn;\u0026thinsp;49.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e.270\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of hours of work at the hospital\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24.97\u0026thinsp;\u0026plusmn;\u0026thinsp;23.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29.72\u0026thinsp;\u0026plusmn;\u0026thinsp;25.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.059\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e28.01\u0026thinsp;\u0026plusmn;\u0026thinsp;25.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e22.16\u0026thinsp;\u0026plusmn;\u0026thinsp;20.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e.009\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e26.57\u0026thinsp;\u0026plusmn;\u0026thinsp;24.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e25.47\u0026thinsp;\u0026plusmn;\u0026thinsp;23.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e.646\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eMultivariable analysis\u003c/p\u003e \u003cp\u003eThe results of the multivariable analysis are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. Serving more than one customer at a time rarely compared to always (aOR\u0026thinsp;=\u0026thinsp;.48) was significantly associated with lower odds of having high knowledge, whereas having good/very good/excellent computer literacy compared to poor/fair) (aOR\u0026thinsp;=\u0026thinsp;2.38) and having practiced MTM (aOR\u0026thinsp;=\u0026thinsp;2.24) were significantly associated with higher odds of having high knowledge (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, Model 1).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariable analyses.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eaOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eModel 1: Logistic regression taking the dichotomous knowledge score (high vs low*) as the dependent variable (R\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.110)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHighest degree from Iraq (yes vs no*)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.320\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.46; 1.29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eServe more than one customer at one time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.133\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlways\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFrequently\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.687\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.56; 1.46\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRarely\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e.034\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.24; .95\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.563\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.52; 3.33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComputer literacy (good/very good/excellent vs poor/fair*)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e.008\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.25; 4.52\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePracticed MTM (yes vs no*)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.44; 3.46\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHours per week working in the hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.166\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.99; 1.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eModel 2: Logistic regression taking the dichotomous attitude score (high vs low*) as the dependent variable (R\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u0026thinsp;\u003cb\u003e=\u0026thinsp;.048)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender (females vs males*)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.096\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.94; 2.09\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWorking hours per week in the hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.988\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e.008\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.979; .997\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnowledge (high vs low*)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e.004\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.24; 2.96\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eModel 3: Logistic regression taking the dichotomous practice score (high vs low*) as the dependent variable (R\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u0026thinsp;\u003cb\u003e=\u0026thinsp;.274)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHighest degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.996\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBachelor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePharmD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.895\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.25; 3.39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaster\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.842\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.39; 3.19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.0001; .000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType of university (private vs public*)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e.037\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.35; .97\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eServe more than one customer at one time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.354\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlways\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFrequently\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.095\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.35; 1.09\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRarely\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.211\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.30; 1.30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.747\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.29; 2.46\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePracticed MTM (yes vs no*)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e.027\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.07; 2.98\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnowledge (high vs low*)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.68; 5.04\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAttitude (high vs low*)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.04; 8.52\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eA higher number of working hours per week in the hospital (aOR\u0026thinsp;=\u0026thinsp;.988) was significantly associated with lower odds of having high attitude, whereas having high knowledge (aOR\u0026thinsp;=\u0026thinsp;1.91) was significantly associated with higher odds of having high attitude (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, Model 2).\u003c/p\u003e \u003cp\u003eHaving studied in a private university compared to public (aOR\u0026thinsp;=\u0026thinsp;.58) was significantly associated with lower odds of having high readiness, whereas having practiced MTM (aOR\u0026thinsp;=\u0026thinsp;1.79), high knowledge (aOR\u0026thinsp;=\u0026thinsp;2.91) and high attitude (aOR\u0026thinsp;=\u0026thinsp;5.09) were significantly associated with higher odds of having high readiness (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, Model 3).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eKey findings\u003c/p\u003e \u003cp\u003eTo our best knowledge, this is the first study to examine Iraqi pharmacists' knowledge of MTM and ADHD. The study reveals that Iraqi community pharmacists have inadequate knowledge, attitudes, and readiness regarding MTM service and ADHD medication management, leading to concerns about the quality of patient care. In addition, this study raises concerns that young pharmacists, who should be up to date in the community, need adequate training in MTM and ADHD. Educating pharmacists on MTM and ADHD through continuing education modules should be a priority and would fill knowledge gaps among pharmacists. There may also be a need to improve and standardize curricula for Iraqi pharmacists and emphasize the importance of clinical guidelines and direct the pharmacy profession toward more effective patient care.\u003c/p\u003e \u003cp\u003eInterpretation\u003c/p\u003e \u003cp\u003eCompared with a recent cross-sectional study in Canada in which pharmacists reported their knowledge of ADHD treatment, self-assessed ADHD knowledge was 5.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.96 on a 10-point scale. This result also suggests the importance of additional ADHD training for pharmacists in Canada [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In a previous U.S. study, pharmacists in Arizona who had no psychiatric training or experience indicated that one of the difficulties in administering psychotropic medications to patients was their lack of knowledge about psychiatric disorders [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Compared with a recent similar study in a neighboring country, Jordan showed a moderate level of knowledge and a positive attitude of pharmacists towards MTM service. The study pointed out the lack of training on MTM care and appropriate support staff [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. The results of our study differed from the study in Malaysia, where pharmacists showed a high level of knowledge and positive attitude toward MTM service. In terms of practice, most pharmacists indicated that they would be willing to become MTM service providers in the future [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMultivariable analysis revealed that serving more than one customer at a time was less likely to be associated with a high level of knowledge. One explanation for this finding is that Iraqi pharmacists generally do not have many patients with whom to apply their knowledge. On the other hand, MTM service require appropriate settings such as workflow, time, and staff to deliver the service, including reviewing patients' medication profiles and providing interventions [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In addition, having good/very good/excellent computer skills (compared with poor/fair) and having practiced MTM were significantly associated with a higher likelihood of having a high level of knowledge. This could be due to the fact that individuals who had practiced MTM were more motivated to learn more about it, resulting in higher knowledge levels. Working longer hours per week in the hospital was significantly associated with a lower likelihood of having a high attitude. However, working conditions, high workload, and stress-related factors in the hospital could contribute to low attitudes toward MTM service performance. A recent Lebanese study showed that adequate workflow, time, and staffing were positively and statistically associated with willingness to perform MTM and active participation in MTM [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. However, a high level of knowledge was significantly associated with a higher likelihood of a high attitude. This suggests that high knowledge levels are more likely to lead to positive attitudes toward the provision of MTM services in Iraqi pharmacies. In addition, studying at a private university was significantly associated with a lower likelihood of having a high attitude than studying at a public university. Several factors could be at play here, such as differences in the quality of education, the availability of resources, or the demographic composition of students at private and public universities. Finally, high knowledge and attitudes about MTM were significantly associated with a higher likelihood of having high readiness. In other words, a better understanding of MTM can lead to more positive attitudes toward MTM, and the likelihood of having high readiness is higher than having less knowledge or less positive attitudes toward MTM.\u003c/p\u003e \u003cp\u003eWeaknesses\u003c/p\u003e \u003cp\u003eA weakness of the present study was that the results may not be representative of the entire pharmacy sector in Iraq. However, Baghdad is the capital of Iraq with an expectedly high density of pharmacists. Pharmacists in Baghdad are likely to be the pioneers who will bring about important changes in pharmacy practice in Iraq. In addition, responses were collected using a self-report questionnaire, which could introduce bias into the information. Reliability analysis of the readiness scale was low. The convenient sampling method used to recruit participants and the unknown refusal rate could lead to selection bias.\u003c/p\u003e \u003cp\u003eFurther research\u003c/p\u003e \u003cp\u003eIn this context, a future survey could be conducted to obtain feedback from pharmacists on the possibility of establishing an MTM service in the clinical setting in Iraq, specialized in different therapeutic areas and provided by Iraqi pharmacists. The future establishment of MTM services in Iraq specializing in different therapeutic areas and provided by Iraqi pharmacists could improve patient care and potentially enhance the role of pharmacists in communities and would provide a special opportunity for Iraqi pharmacists to participate in a broader range of patient care.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOur findings indicate that Iraqi pharmacists' knowledge, attitude, and readiness regarding MTM service and ADHD medication management are inadequate. This study highlights the urgent need for effective educational strategies that should better prepare pharmacists for their potential roles in community, MTM service, and ADHD care. Continuing education on current clinical guidelines could be an effective approach to address the knowledge gap. It may be necessary to improve and standardize pharmacist curricula related to therapeutic areas and emphasize the importance of clinical guidelines to equip pharmacists with the knowledge they need to provide quality patient care and engage in a broader spectrum of patient care.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eThe authors gratefully acknowledge the contribution of pharmacy students of the Scientific Society of the College of Pharmacy at the American University of Iraq - Baghdad (AUIB) for their valuable help in visiting 480 community pharmacies in Baghdad, the capital of Iraq, to collect the data. The authors would also like to thank all the participating pharmacists who spent their valuable time to complete the questionnaire.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests:\u003c/strong\u003e The authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u003c/strong\u003e All authors contributed to the conception and design of the study. Preparation of the material and data collection were led by Zahraa Al-Dujaili and Achraf Al Faraj, while data analysis was conducted by Souheil Hallit. The first draft of the manuscript was written by Zahraa Al-Dujaili, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability:\u003c/strong\u003e The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003cbr\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMarupuru S, Roether A, Guimond AJ, et al. A Systematic Review of Clinical Outcomes from Pharmacist Provided Medication Therapy Management (MTM) among Patients with Diabetes, Hypertension, or Dyslipidemia. Healthcare. 2022;10:1207. \u003c/li\u003e\n\u003cli\u003eFerreri SP, Hughes TD, Snyder ME. Medication Therapy Management: Current Challenges. Integr Pharm Res Pract. 2020;Volume 9:71\u0026ndash;81. \u003c/li\u003e\n\u003cli\u003eHohmeier KC, Wheeler JS, Turner K, et al. Targeting adaptability to improve Medication Therapy Management (MTM) implementation in community pharmacy. Implement Sci. 2019;14:99. \u003c/li\u003e\n\u003cli\u003ePellegrino AN, Martin MT, Tilton JJ, et al. Medication Therapy Management Services: Definitions and Outcomes. Drugs. 2009;69:393\u0026ndash;406. \u003c/li\u003e\n\u003cli\u003eSmith M, Bates DW, Bodenheimer T, et al. Why Pharmacists Belong In The Medical Home. Health Aff (Millwood). 2010;29:906\u0026ndash;13. \u003c/li\u003e\n\u003cli\u003eChisholm-Burns MA, Kim Lee J, Spivey CA, et al. US Pharmacists\u0026rsquo; Effect as Team Members on Patient Care: Systematic Review and Meta-Analyses. Med Care. 2010;48:923\u0026ndash;33. \u003c/li\u003e\n\u003cli\u003eKogut S, Goldstein E, Charbonneau C, et al. Improving medication management after a hospitalization with pharmacist home visits and electronic personal health records: an observational study. Drug Healthc Patient Saf. 2014;1. \u003c/li\u003e\n\u003cli\u003eBunting BA, Smith BH, Sutherland SE. The Asheville Project: Clinical and economic outcomes of a community-based long-term medication therapy management program for hypertension and dyslipidemia. J Am Pharm Assoc. 2008;48:23\u0026ndash;31. \u003c/li\u003e\n\u003cli\u003eRamalho de Oliveira D, Brummel AR, Miller DB. Medication Therapy Management: 10 Years of Experience in a Large Integrated Health Care System. J Manag Care Pharm. 2010;16:185\u0026ndash;95. \u003c/li\u003e\n\u003cli\u003eChau SH, Jansen APD, van de Ven PM, Clinical medication reviews in elderly patients with polypharmacy: a cross-sectional study on drug-related problems in the Netherlands. Int J Clin Pharm. 2016;38:46\u0026ndash;53. \u003c/li\u003e\n\u003cli\u003eModig S, Holmdahl L, Bondesson \u0026Aring;. Medication reviews in primary care in Sweden: importance of clinical pharmacists\u0026rsquo; recommendations on drug-related problems. Int J Clin Pharm. 2016;38:41\u0026ndash;5. \u003c/li\u003e\n\u003cli\u003eCabral MDI, Liu S, Soares N. Attention-deficit/hyperactivity disorder: diagnostic criteria, epidemiology, risk factors and evaluation in youth. Transl Pediatr. 2020;9:S104\u0026ndash;13. \u003c/li\u003e\n\u003cli\u003eYuen T, Zhang H, Bonin RP. Pharmacists\u0026rsquo; knowledge, experiences and perceptions of treatments for attention-deficit/hyperactivity disorder. Can Pharm J Rev Pharm Can. 2021;154:110\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eCaye A, Swanson JM, Coghill D, et al. Treatment strategies for ADHD: an evidence-based guide to select optimal treatment. Mol Psychiatry. 2019;24:390\u0026ndash;408. \u003c/li\u003e\n\u003cli\u003eBrown KA, Samuel S, Patel DR. Pharmacologic management of attention deficit hyperactivity disorder in children and adolescents: a review for practitioners. Transl Pediatr. 2018;7:36\u0026ndash;47. \u003c/li\u003e\n\u003cli\u003eToomey SL, Sox CM, Rusinak D, et al. Why Do Children With ADHD Discontinue Their Medication? Clin Pediatr (Phila). 2012;51:763\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eLee KC, Kim E, Kim J, et al. Development of an innovative adult attention-deficit hyperactivity disorder clinic. Ment Health Clin. 2020;10:296\u0026ndash;300. \u003c/li\u003e\n\u003cli\u003eScott KM, Baur L, Barrett J. Evidence-Based Principles for Using Technology-Enhanced Learning in the Continuing Professional Development of Health Professionals. J Contin Educ Health Prof. 2017;37:61\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eDomiati S, Sacre H, Lahoud N, et al. Knowledge of and readiness for medication therapy management among community pharmacists in Lebanon. Int J Clin Pharm. 2018;40:1165\u0026ndash;74. \u003c/li\u003e\n\u003cli\u003eFera T, Bluml BM, Ellis WM. Diabetes Ten City Challenge: Final economic and clinical results. J Am Pharm Assoc. 2009;49:383\u0026ndash;91. \u003c/li\u003e\n\u003cli\u003eMoczygemba LR, Barner JC, Roberson K. Texas pharmacists\u0026rsquo; opinions about and plans for provision of medication therapy management services. J Am Pharm Assoc. 2008;48:38\u0026ndash;55a. \u003c/li\u003e\n\u003cli\u003ePindolia VK, Stebelsky L, Romain TM, et al. Mitigation of Medication Mishaps via Medication Therapy Management. Ann Pharmacother. 2009;43:611\u0026ndash;20. \u003c/li\u003e\n\u003cli\u003eOladapo AO, Rascati KL. Review of Survey Articles Regarding Medication Therapy Management (MTM) Services/Programs in the United States. J Pharm Pract. 2012;25:457\u0026ndash;70. \u003c/li\u003e\n\u003cli\u003eAl-Tameemi NK, Sarriff A. Knowledge, attitude and practice of pharmacists on medication therapy management: a survey in Hospital Pulau Pinang, Penang, Malaysia. J Pharm Health Care Sci. 2019;5:1. \u003c/li\u003e\n\u003cli\u003eJarab AS, Al-Qerem W, Mukattash TL, et al. Pharmacists\u0026rsquo; knowledge and attitudes toward medication therapy management service and the associated challenges and barriers for its implementation. Saudi Pharm J. 2022;30:842\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eGerman A, Johnson L, Ybarra G, et al. Assessment of pharmacists\u0026rsquo; self-reported preparedness to provide pharmacotherapy services to individuals with psychiatric disorders. Ment Health Clin. 2018;8:1\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eErku DA, Ayele AA, Mekuria AB, et al. The impact of pharmacist-led medication therapy management on medication adherence in patients with type 2 diabetes mellitus: a randomized controlled study. Pharm Pract. 2017;15:1026\u0026ndash;1026. \u003cbr\u003e \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"international-journal-of-clinical-pharmacy","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ijcp","sideBox":"Learn more about [International Journal of Clinical Pharmacy](https://www.springer.com/journal/11096)","snPcode":"11096","submissionUrl":"https://submission.nature.com/new-submission/11096/3","title":"International Journal of Clinical Pharmacy","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Clinical Pharmacy, Medication Therapy Management, Attention Deficit Hyperactivity Disorder, Mental Health, Community Pharmacists","lastPublishedDoi":"10.21203/rs.3.rs-2608007/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2608007/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground\u003c/p\u003e\n\u003cp\u003eMedication Therapy Management (MTM) is a patient-centered, collaborative service that optimizes drug therapy and improves clinical outcomes, including quality of life. Pharmacists play a critical role in MTM service and are uniquely positioned to provide comprehensive medication management for patients with attention deficit hyperactivity disorder (ADHD).\u003c/p\u003e\n\u003cp\u003eAim\u003c/p\u003e\n\u003cp\u003eThe aim of this study was to assess the knowledge, attitude, and readiness of Iraqi pharmacists regarding MTM service in general and medication management of ADHD patients.\u003c/p\u003e\n\u003cp\u003eMethod\u003c/p\u003e\n\u003cp\u003eA cross-sectional study was conducted among 480 Iraqi pharmacists working in community pharmacies in Baghdad. Data were collected using a pre-validated 34-item self-administered questionnaire.\u003c/p\u003e\n\u003cp\u003eResults\u003c/p\u003e\n\u003cp\u003eResults showed that only 26.5% of pharmacists had good knowledge, 30.4% had good attitude, and 30.8% had high readiness regarding MTM service and ADHD medication management. Multivariate analyses revealed that a higher number of hours worked per week in the hospital was significantly associated with a lower likelihood of a high attitude, whereas experience with MTM, high knowledge, and high attitude were significantly associated with a higher likelihood of high readiness.\u003c/p\u003e\n\u003cp\u003eConclusion\u003c/p\u003e\n\u003cp\u003eThe findings of this study indicate that knowledge, attitudes, and readiness regarding MTM service and ADHD medication management are inadequate. Therefore, there is an urgent need for effective educational strategies to better prepare pharmacists for their potential role in the community, particularly for the provision of MTM service and ADHD care. In this way, pharmacists can better assist patients in managing their medications, improve clinical outcomes and ultimately increase the efficiency of the overall health care system.\u003c/p\u003e","manuscriptTitle":"Knowledge, Attitude, and Readiness of Pharmacists in Iraq toward Medication Therapy Management for Patients with Attention Deficit Hyperactivity Disorder: A Cross-sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-03-07 18:14:19","doi":"10.21203/rs.3.rs-2608007/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"","date":"2023-03-05T13:04:31+00:00","index":0,"fulltext":""},{"type":"editorInvited","content":"International Journal of Clinical Pharmacy","date":"2023-02-23T08:18:17+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2023-02-23T06:30:08+00:00","index":"","fulltext":""},{"type":"submitted","content":"International Journal of Clinical Pharmacy","date":"2023-02-21T03:22:12+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"international-journal-of-clinical-pharmacy","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ijcp","sideBox":"Learn more about [International Journal of Clinical Pharmacy](https://www.springer.com/journal/11096)","snPcode":"11096","submissionUrl":"https://submission.nature.com/new-submission/11096/3","title":"International Journal of Clinical Pharmacy","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"ffa8ae69-89c3-46c6-9951-13bfe162cc86","owner":[],"postedDate":"March 7th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2023-09-18T15:05:08+00:00","versionOfRecord":{"articleIdentity":"rs-2608007","link":"https://doi.org/10.1007/s11096-023-01628-3","journal":{"identity":"international-journal-of-clinical-pharmacy","isVorOnly":false,"title":"International Journal of Clinical Pharmacy"},"publishedOn":"2023-09-11 15:02:09","publishedOnDateReadable":"September 11th, 2023"},"versionCreatedAt":"2023-03-07 18:14:19","video":"","vorDoi":"10.1007/s11096-023-01628-3","vorDoiUrl":"https://doi.org/10.1007/s11096-023-01628-3","workflowStages":[]},"version":"v1","identity":"rs-2608007","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2608007","identity":"rs-2608007","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}