Dispensing Practice of Non-Prescribed Medications in Community Pharmacies in Jordan: A Simulated Patient Study
Main Article Content
Keywords
Antibiotics , oral contraceptive, Community pharmacy, stimulated patient
Abstract
Objectives: In Jordan, community pharmacies play a critical role in the healthcare system, often serving as the first point of contact for patients seeking medical advice and medication. As most antibiotics and oral contraceptive pills (OCPs) are available over the counter, it is the pharmacist’s professional duty to verify and advise patients about all aspects of using these medications. However, the lack of stringent regulatory oversight and adherence to dispensing guidelines has led to concerns about the inappropriate dispensing of medications, posing significant risks to patient safety and contributing employed simulated patient (SP) methodology to evaluate medication dispensing practices in community pharmacies across four Jordanian governorates. Eight study members were trained for three common scenarios: common cold, urinary tract infection (UTI), and oral contraceptives. Data were collected anonymously using Google Forms. Results: The study assessed medication dispensing practices across 103 pharmacies in Jordan using simulated patients. Dispensing without a prescription occurred in 90.3% of visits, with the highest rates observed for common colds (100%), followed by UTIs (97.1%) and contraceptive pills (73.5%). The most common inquiry was ‘Who is the medicine for?’ (85.3%), with variations across scenarios. Notably, antibiotics were prescribed in 51.4% (n = 18) of common cold cases and 73.5% (n = 25) of UTI cases. While guidance on dosage was provided in 82.3% of interactions, side effects were mentioned in only 17.7%. Communication skills among pharmacists were limited, with only 15.9% (n = 14) checking patient understanding. Conclusion: Strict regulatory measures and guidelines are needed to improve the quality of pharmacist consultations on OCPs and over-the-counter pharmaceutical usage in order to ensure patient safety.
References
practice feedback in Jordanian community pharmacy settings. Saudi Pharmaceutical Journal. 2022 Mar 1;30(3):225–9.
2. Basheti IA, Mhaidat NM, Al-Qudah R, Nassar R, Othman B, Mukattash TL. Primary health care policy and vision for community
pharmacy and pharmacists in Jordan. Pharm Pract (Granada). 2020 Dec 5;18(4):2184–2184.
3. Shakya Shrestha S, Koju P, Shrestha S, Koju Shrestha R, Shahukhal S, Shrestha D, Shrestha R, Xu DR, Cai Y, Zhou J. Use
of Unannounced Standardized Patient to Assess Quality of Care in Community Pharmacies / Medicine Shops: A Pilot, Cross-
Sectional Study. J Nepal Health Res Counc. 2022 Nov 3;20(2):524–33.
4. Abdel-Qader DH, Albassam A, Ismael NS, El-Shara’ AA, Shehri A, Almutairi FS, Al-Harbi DM, Al Zahrani MM, Chen LC,
Al Mazrouei N, Mohamed Ibrahim O. Awareness of Antibiotic Use and Resistance in Jordanian Community. J Prim Care
Community Health. 2020 Dec;11:2150132720961255.
5. Franklin BD, O’Grady K. Dispensing errors in community pharmacy: frequency, clinical significance and potential impact of
authentication at the point of dispensing. International Journal of Pharmacy Practice. 2007;15(4):273–81.
6. Flynn EA, Barker KN, Carnahan BJ. National observational study of prescription dispensing accuracy and safety in 50
pharmacies. J Am Pharm Assoc (Wash). 2003;43(2):191–200.
7. Knudsen P, Herborg H, Mortensen AR, Knudsen M, Hellebek A. Preventing medication errors in community pharmacy:
frequency and seriousness of medication errors. Qual Saf Health Care. 2007 Aug;16(4):291–6.
8. Ahmad T, Khan FU, Ali S, Rahman AU, Ali Khan S. Assessment of without prescription antibiotic dispensing at community
pharmacies in Hazara Division, Pakistan: A simulated client’s study. PLoS One. 2022 Feb 17;17(2):e0263756.
9. Nadgir CA, Biswas DA. Antibiotic Resistance and Its Impact on Disease Management. Cureus. 15(4):e38251.
10. Al-Azzam SI, Al-Husein BA, Alzoubi F, Masadeh MM, Al-Horani MAS. Self-medication with antibiotics in Jordanian
population. Int J Occup Med Environ Health. 2007;20(4):373–80.
11. Bardaweel SK, Akour AA, Kilani MVZ. Current knowledge, attitude, and patterns of oral contraceptives utilization among
women in Jordan. BMC Womens Health. 2015 Dec 14;15:117.
12. Glassman PA, Luck J, O’Gara EM, Peabody JW. Using standardized patients to measure quality: evidence from the literature
and a prospective study. Jt Comm J Qual Improv. 2000 Nov;26(11):644–53.
13. Watson MC Dr, Norris P, Granas AG. A systematic review of the use of simulated patients and pharmacy practice research.
International Journal of Pharmacy Practice. 2006 Jun 1;14(2):83–93.
14. Shi L, Chang J, Liu X, Zhai P, Hu S, Li P, Hayat K, Kabba JA, Feng Z, Yang C, Jiang M, Zhao M, Hu H, Fang Y. Dispensing
Antibiotics without a Prescription for Acute Cough Associated with Common Cold at Community Pharmacies in Shenyang,
Northeastern China: A Cross-Sectional Study. Antibiotics. 2020 Apr;9(4):163.
15. Zawahir S, Lekamwasam S, Aslani P. Community pharmacy staff’s response to symptoms of common infections: a pseudopatient study. Antimicrobial Resistance & Infection Control. 2019 Mar 29;8(1):60.
16. Division of Reproductive Health, Kenya Ministry of Public Health and Sanitation. Checklist for Screening Clients Who Want
to Initiate Combined Oral Contraceptives. https://www.fhi360.org/wp-content/uploads/drupal/documents/checklist-coc-kenya.pdf.
17. Lansang MA, Lucas-Aquino R, Tupasi TE, Mina VS, Salazar LS, Juban N, Limjoco TT, Nisperos LE, Kunin CM. Purchase of
antibiotics without prescription in Manila, the Philippines. Inappropriate choices and doses. J Clin Epidemiol. 1990;43(1):61–7. 18. Dameh M, Green J, Norris P. Over-the-counter sales of antibiotics from community pharmacies in Abu Dhabi. Pharm World
Sci. 2010 Oct;32(5):643–50.
19. Chalker J, Ratanawijitrasin S, Chuc NTK, Petzold M, Tomson G. Effectiveness of a multi-component intervention on dispensing practices at private pharmacies in Vietnam and Thailand--a randomized controlled trial. Soc Sci Med. 2005 Jan;60(1):131–41.
20. Volpato DE, de Souza BV, Dalla Rosa LG, Melo LH, Daudt CAS, Deboni L. Use of antibiotics without medical prescription.
Braz J Infect Dis. 2005 Aug;9(4):288–91.
21. Kagashe GAB, Minzi O, Matowe L. An assessment of dispensing practices in private pharmacies in Dar-es-Salaam, Tanzania. Int J Pharm Pract. 2011 Feb;19(1):30–5.
22. Contopoulos-Ioannidis DG, Koliofoti ID, Koutroumpa IC, Giannakakis IA, Ioannidis JP. Pathways for inappropriate dispensing
of antibiotics for rhinosinusitis: a randomized trial. Clin Infect Dis. 2001 Jul 1;33(1):76–82.
23. Foroutan N, Dabaghzadeh F. Evaluating the practice of Iranian community pharmacists regarding oral contraceptive pills using simulated patients. Pharm Pract (Granada). 2016 Dec 16;14(4):745–745.
24. Obreli-Neto PR, Pereira LRL, Guidoni CM, Baldoni ADO, Marusic S, De Lyra-Júnior DP, De Almeida KL, Pazete ACM,
Do Nascimento JD, Kos M, Girotto E, Cuman RKN. Use of Simulated Patients to Evaluate Combined Oral Contraceptive Dispensing Practices of Community Pharmacists. Postma M, editor. PLoS ONE. 2013 Dec 4;8(12):e79875.
25. Matlow J, Koren G. Is carbamazepine safe to take during pregnancy? Can Fam Physician. 2012 Feb;58(2):163–4.
26. Landau SC, Tapias MP, McGhee BT. Birth control within reach: a national survey on women’s attitudes toward and interest in pharmacy access to hormonal contraception. Contraception. 2006 Dec;74(6):463–70.
27. Weiss MC, Booth A, Jones B, Ramjeet S, Wong E. Use of simulated patients to assess the clinical and communication skills of
community pharmacists. Pharm World Sci. 2010 Jun;32(3):353–61.
28. Mesquita AR, Lyra DP, Brito GC, Balisa-Rocha BJ, Aguiar PM, de Almeida Neto AC. Developing communication skills in
pharmacy: a systematic review of the use of simulated patient methods. Patient Educ Couns. 2010 Feb;78(2):143–8.