Cross-sectional studyindependent cross-checkabstract checked I-PPI-120 standard review
Pharmacists in Egypt and Iraq need more PPI training
Knowledge, Attitudes, and Practices of Community Pharmacists Regarding Proton Pump Inhibitor (PPI) Use: A Cross-Sectional Study.
Overview
Moustafa HAM et al.. Healthcare (Basel) 2025 · PMID 40648613 · DOI 10.3390/healthcare13131588
A survey of 527 pharmacists found gaps in knowledge about when PPIs are needed and when to stop them.
Does the study support the specific claim? Partly · Methodological quality: very low
Plain-language summary
Study explained simply
- What did the researchers want to find out?
Assess pharmacists' PPI knowledge.
- How was the study done?
Online survey.
- How many people, animals or samples were studied?
527 pharmacists in Egypt and Iraq.
- What was actually found?
Moderate knowledge; gaps on indications and deprescribing.
- How large was the observed effect?
Not applicable.
- What do the results mean in everyday life?
Advice at the pharmacy may not always follow guidelines.
- What are the study's limitations?
Self-report; no sales data.
- What does it say about Elawady's specific claim?
Weakly supports overuse claim for Egypt.
- Do the results apply to Germany and Europe?
Not European.
- What can explicitly not be concluded from this study?
Cannot quantify overuse in Egypt.
Scientific in-depth review
1. Full reference
- Authors
- Moustafa HAM et al.
- Journal
- Healthcare (Basel)
- Year
- 2025
- Identifier
- PMID 40648613 DOI 10.3390/healthcare13131588
- Verification
- verified – PubMed efetch 2026-10-26 + Crossref 2026-10-26
- Retracted
- no
- Corrections
- none
- Extent checked
- abstract only
- Conflicts of interest and funding
Princess Nourah bint Abdulrahman University; no conflicts declared
2. Research question
What do community pharmacists in Egypt and Iraq know and do about PPI use?
3. Study design and population
- Study design
- Cross-sectional study – Online cross-sectional knowledge-attitude-practice survey
- Population
Community pharmacists in Egypt and Iraq
- Country
Egypt, Iraq
- Period
May-July 2024
- Sample size
527 pharmacists
- Inclusion and exclusion criteria
Practising community pharmacists
4. Methods and endpoints
- Exposure / intervention
Not applicable
- Comparator
Not applicable
- Endpoints
Knowledge (17 items), attitude (11), practice (6) scores
- Statistical methods
Medians; correlations
5. Actual results
- Results
Median knowledge 11/17, attitude 9/11, practice 5/6; higher knowledge with >20 years' experience and guideline use. Background: 25-70% of PPI prescriptions worldwide lack an evidence-based indication; the authors call Egypt and Iraq 'high-use' markets.
- Absolute risks
Not applicable
- Authors' conclusion
Pharmacists' knowledge of judicious PPI use needs improvement.
6. Strengths
- Only identified Egyptian data on PPI dispensing practice
7. Weaknesses
- Self-reported survey; convenience sample
- No prescription data
8. Risk of bias
- Orienting tool
- none applicable
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- high
- Rationale
Self-selection; self-report.
9. Assessment of the statistical interpretation
Descriptive.
10. Relevance to the specific claim
Weak regional context supporting the claim that PPIs are widely dispensed in Egypt with knowledge gaps.
11. Independent contrary findings
Does not measure inappropriate use rates.
12. Transferability to Germany and Europe
Egypt/Iraq-specific.
13. Overall methodological judgement
Low-quality regional support only.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | very low |
| Risk of bias | high |
| Precision of results | not applicable |
| Directness | indirect |
| Reproducibility | unknown |
| Consistency with the overall evidence | unknown |
| Regional transferability | high |
| Adequacy of the interpretation (by the archive) | not applicable |
14. Open questions
Egyptian prescription and OTC sales data.