Assessment of disease management of insomnia at community pharmacies through simulated visits in Pakistan
Keywords:Sleep Initiation and Maintenance Disorders, Community Pharmacy Services, Professional Practice, Pharmacies, Patient Simulation, Pakistan
Objective: The study aimed to document the state of insomnia management at community pharmacies in Pakistan.
Methods: A cross-sectional study was conducted at randomly selected 371 pharmacies in three cities of Pakistan. Simulated patient visits were performed to collect information on case management of insomnia in terms of history taking and patient counseling at community pharmacies. The data was coded, entered and analyzed by using SPSS Version 16. Kruskal-Wallis and Mann Whitney tests (p<0.05) were performed to find out differences.
Results: The patients were mainly handled by salesman 83.8% (n=311), by pharmacist 3.5% (n=13) and pharmacy assistants 12.7% (n=47). The mean dispensing time was 1.11 minutes (SD=5.61) with the range of 0.5 - 6 minutes. Of the 371 simulated patients who visited the pharmacies, 72.8% (n=270) subjects were given medicines and 24.3% (n=90) subjects were referred to the doctor for treatment of insomnia. 61.8% (n=193) of the subjects were given benzodiazepines, 35.6% (n=111) antihistamines and 2.6% (n=8) NSAIDs at community pharmacies in the three cities. The mean cost of treatment in case of insomnia was PKR12.7 (SD=10.13, median=10).
Conclusions: The disease management of insomnia by community pharmacies in Pakistan is not appropriate. The overall process of history taking, medication counselling and referral practices at community pharmacies either located in rural or urban setting and irrespective of the provider type and location of pharmacies, in the three cities is limited.
2. LeBlanc M, Mérette C, Savard J, Ivers H, Baillargeon L, Morin CM. Incidence and risk factors of insomnia in a population-based sample. Sleep. 2009;32(8):1027-1037.
3. Daley M, Morin CM, LeBlanc M, Grégoire JP, Savard J. The economic burden of insomnia: direct and indirect costs for individuals with insomnia syndrome, insomnia symptoms, and good sleepers. Sleep. 2009;32(1):55-64.
4. Kupfer DJ, Reynolds CF 3rd. Management of insomnia. N Engl J Med. 1997;336(5):341-346.
5. Kippist C, Wong K, Bartlett D, Saini B. How do pharmacists respond to complaints of acute insomnia? A simulated patient study. Int J Clin Pharm. 2011;33(2):237-245. doi: 10.1007/s11096-011-9482-5
6. Brunette MF, Noordsy DL, Xie H, Drake RE. Benzodiazepine use and abuse among patients with severe mental illness and co-occurring substance use disorders. Psychiatr Serv. 2003;54(10):1395-1401.
7. Fuller JM, Wong KK, Krass I, Grunstein R, Saini B. Sleep disorders screening, sleep health awareness, and patient follow-up by community pharmacists in Australia. Patient Educ Couns. 2011;83(3):325-335. doi: 10.1016/j.pec.2011.05.004
8. Black J, Saini B, Wong K, The role of pharmacists in improving the management of sleep disorders in the community. Respirology, 2007;12(1):A24.
9. Stone L. Good Pharmacy Practice (GPP) in Developing Countries 1997 1997; Available from: http://www.fip.org/files/www2/pdf/gpp/GPP_CPS_Report.pdf (accesed 2009 20th November).
10. Berih AA, McIntyre L, Lynk AD. Pharmacy dispensing practices for Sudanese children with diarrhoea. Public Health. 1989;103(6):455-458.
11. Hogan R. Educating Private drug sellers. Dialogue on Diarrhoea, 1994(55):1.
12. Ross-Degnan D, Soumerai SB, Goel PK, Bates J, Makhulo J, Dondi N, Sutoto, Adi D, Ferraz-Tabor L, Hogan R. The impact of face-to-face educational outreach on diarrhoea treatment in pharmacies. Health Policy Plan. 1996;11(3):308-318.
13. Tawfik Y, Northrup R, Jones SP. Utilizing the Potential of Formal and Informal Private Practitioners in Child Survival, SARA: Washington, DC;2002.
14. Chalker J, Chuc NT, Falkenberg T, Tomson G.Private pharmacies in Hanoi, Vietnam: a randomized trial of a 2-year multi-component intervention on knowledge and stated practice regarding ARI, STD and antibiotic/steroid requests. Trop Med Int Health. 2002;7(9):803-810.
15. Oun S, Edward-Raj A, Ojuola O, Bowman G, Long WM. Assessing the quality of health services provided by informal drug sellers in rural Cambodia. in American Public Health Association 133rd Annual Meeting & Exposition.Philadelphia, 2005. https://apha.confex.com/apha/133am/techprogram/paper_111013.htm (accessed 2009 20th November).
16. Nsimba SE. Assessing the impact of educational intervention for improving management of malaria and other childhood illnesses in Kibaha District-Tanzania. East Afr J Public Health. 2007;4(1):5-11.
17. Benjamin H, Smith F, Motawi MA. Drugs dispensed with and without a prescription from community pharmacies in a conurbation in Egypt. East Mediterranean Health J. 1996;2(3):506-514.
18. Rabbani F, Cheema FH, Talati N, Siddiqui S, Syed S, Bashir S, Zuberi LZ, Shamim A, Mumtaz Q. Behind the counter: pharmacies and dispensing patterns of pharmacy attendants in Karachi. J Pak Med Assoc. 2001;51(4):149-153.
19. Qidwai W, Krishanani MK, Hashmi S, Afridi M, Ali RA. Private Drug Sellers Education in Improving Prescribing Practices. J Coll Physicians Surg Pak. 2006;16(12):743-746.
20. Chalker JC. Interventions for improved prescribing and dispensing of medicines in Nepal, Thailand and Vietnam, in Public Health. Stockholm Karolinska Institutet: 2003.
21. Goodman CA, Mutemi WM, Baya EK, Willetts A, Marsh V. The cost-effectiveness of improving malaria home management: shopkeeper training in rural Kenya. Health Policy Plan. 2006;21(4):275-288.
22. Basak SC, Prasad GS, Arunkumar A, Senthilkumar S. An attempt to develop community pharmacy practice : Results of two surveys and two workshops conducted in tamilnadu. Indian J Pharm Sci. 2005:67(3):362-367.
23. Babar Z. Medicalising Pakistan. 2007; Available from: http://www.chowk.com/articles/11520 (accesed 2009 20th November).
24. WHO. How to Investigate Drug Use in Health Facilities Geneve;WHO:1993.
25. Israel GD. Determining sample size. University of Florida. 2007. http://edis.ifas.ufl.edu/pd006 (accessed 2009 20th November).
26. Kashyap KC, Nissen LM, Smith SS, Douglas JA, Kyle GJ Can a community pharmacy sleep assessment tool aid the identification of patients at risk of sleep disorders in the community: a pilot study. Integrated Pharmacy Research and Practice, 2012;1:3-12.
27. Paredes NP, Miasso AI, Tirapelli CR. Consumption of benzodiazepines without prescription among first-year nursing students at the University of Guayaquil, school of nursing, Ecuador. Rev Lat Am Enfermagem. 2008;16(Spec No):634-669.
28. Goel P, Ross-Degnan D, Berman P, Soumerai S. Retail pharmacies in developing countries: A behavior and intervention framework. Soc Sci Med. 1996;42(8):1155-1161.
29. Kashyap KC, Nissen LM, Smith S, Kyle GJ. Supply of non-prescription “pharmacist-only” doxylamine tablets in Australian community pharmacies: a simulated patient study. 21st Congress of the European Sleep Research Society. Paris. 2012.