Assessing pharmacy staff practices and knowledge of off-label drug use in Ministry of Health Hospitals, Saudi Arabia: A cross-sectional study

Despite the growing prevalence of off-label prescribing, there is limited research exploring pharmacists' actual knowledge and practices, particularly in the Saudi context. Existing literature mainly focuses on physicians, leaving a gap in understanding pharmacists' readiness to handle such prescriptions. This study aimed to assess the knowledge and practices of pharmacy staff in Saudi Arabia regarding off-label drug use and examined the impact of education, age, gender, and experience on these outcomes. A cross-sectional survey was conducted over 6 months (February-July 2024) targeting registered pharmacy staff working in healthcare settings in Riyadh and Jeddah, Saudi Arabia. Participants completed a content validated, structured questionnaire designed to assess their knowledge and practices related to off-label drug use. The survey also captured demographic and professional data, including age, gender, education level, hospital type, and years of experience. Among 302 pharmacy staff, the mean knowledge score was 54.7 ± 22.3, indicating moderate knowledge while Practice scores were higher (mean 68.2 ± 17.8), with over 75% correctly managing off-label prescriptions. Logistic regression showed hospital level as a significant predictor, staff in tertiary hospitals were more knowledgeable (OR = 4.5) and practiced better (OR = 3.6). Demographics had no significant impact. No association was found between self-rated knowledge and actual knowledge, but poor self-rated familiarity strongly correlated with poor practice (P < .0001). These findings underscore the need for SFDA-aligned training and regulatory initiatives to improve off-label prescribing, especially in primary and secondary care. Periodic national assessments are essential to monitor and enhance pharmacy staff competence amid ongoing healthcare reforms.