Administration Technique of Intranasal Corticosteroid Sprays Among Nepali Pharmacists: Cross-Sectional Study

Background: Allergic rhinitis is a common condition affecting up to 40% of people worldwide, with a notably high prevalence in South Asia. The primary treatment for moderate to severe allergic rhinitis is intranasal corticosteroid sprays (INCS), the use of which is typically demonstrated to patients by registered pharmacists. However, many patients do not use these sprays correctly. Objective: This study evaluated the proficiency of pharmacists in demonstrating the correct technique for using INCS and the factors contributing to proper technique. Methods: In a cross-sectional survey of 365 registered pharmacists in the Kathmandu Valley, Nepal, a trained observer used a standardized 12-step checklist to assess each pharmacist's technique for using INCS. The 12-step checklist was created after studying international guidelines, studies conducted in Nepal, international research articles, and instructional pamphlets. Simple random sampling was done to collect the data from community pharmacies in Kathmandu district. Demographics, education, experience, previous training, and instructional materials use were recorded. A total of 12 marks were awarded for all 12 steps, with one mark given for each step. Proficiency was classified as "adequate" if more than 6 marks were obtained. Results: Out of 365 pharmacists, 239 (65.5%) were male and 126 (34.5%) were female. Overall, 216 pharmacists (59.2%) were aged 26 years or younger and 235 pharmacists (69.9%) held a diploma in pharmacy. We found that 193 (52.9%) pharmacists demonstrated inadequate technique, while only 172 (47.1%) showed adequate skill overall. However, only 22 pharmacists (6%) demonstrated all 5 critical steps. The likelihood of providing appropriate counseling on the use of INCS was significantly correlated with multiple independent factors. Those with a diploma in pharmacy had a 97% lower likelihood of providing appropriate counseling compared with those with a bachelor's degree in pharmacy and above (P