Evaluation of the community pharmacist’s behavior towards a prescription of antidiabetic and antiasthma drugs
Keywords:Medication Errors, Community Pharmacy Services, Professional Practice, United Arab Emirates
Objective: The objective of this study is to assess the performance of community pharmacist towards antidiabetic and antiasthma prescriptions, and also to assess the lack of information provided by community pharmacists regarding patient counseling and missing data, using a simulated patient technique.
Methods: A prescription including antidiabetic and antiasthma drugs was used by simulated patient to assess community pharmacist’s performance in 194 pharmacies. A performance assessment sheet was used to measure the patient counseling process. A quantitative descriptive and comparative analysis was done for the collected data. Pearson chi-square test (crosstabs) was used with a level of significance 95%).
Results: The analysis of the 194 pharmacies visited revealed that most of the pharmacists were male (61%), Arabs (35%) and Indians (55%) with some other nationalities. The dispensing time in the pharmacy ranged between 2 to 10 minutes. Spending time with patients was not affected by gender (p-value 0.087), slightly affected by nationality (p-value 0.04), and highly affected by age (p-value 0.002) leaning towards older pharmacists who spent more time with patients than younger pharmacists. Most pharmacists (90%) started preparing the prescription once they received the prescription with no actual prescription screening. fifty five percent of the pharmacists asked about the duration of the treatment after preparing the prescription. ninety six percent did not counsel patients about diet, exercise and lifestyle changes. Less than 40% asked if the prescription was intended to be used for the same patient.
Conclusion: This study recommends that health authorities consider follow up plans in order to ensure the best pharmaceutical care is provided by community pharmacies.
2. Farris KB, Kirking DM. Assessing the quality of pharmaceutical care. II. Application of concepts of quality assessment from medical care. Ann Pharmacother. 1993;27(2):215-223.
3. Yancey V, Yakimo R, Perry A, Timothy B, McPherson.Perceptions of pharmaceutical care among pharmacists offering compounding services. J Am Pharm Assoc. 2008;48(4):508-514.
4. Candace BW, Nykamp D, Ellington AM. Patient-Guided Counseling in the Community Pharmacy Setting. J Am Pharm Assoc. 2000;40(6):765-772.
5. Amsler MR, Murray MD, Tierney WM, Brewer N, Harris LE, Marrero DG, Weinberger M. Pharmaceutical Care in Chain Pharmacies: Beliefs and Attitudes of Pharmacists and Patients. J Am Pharm Assoc (Wash). 2001;41(6):850-855.
6. Montgomery AT, Sporrong SK, Tully MP, Lindblad AK. Follow-up of patients receiving a pharmaceutical care service in Sweden. J Clin Pharm Ther. 2008;33(6):653-662.
7. Uema SA, Vega EM, Armando PD, Fontana D. Barriers to pharmaceutical care in Argentina. Pharm World Sci. 2008;30(3):211-215.
8. Heaton PC, Cluxton RJ Jr., Moomaw CJ. Acetaminophen Overuse in the Ohio Medicaid Population. J Am Pharm Assoc. 2002;43(6):680-684.
9. Farris KB, Schopflocher DP. Between intention and behavior: an application of community pharmacists' assessment of pharmaceutical care. Soc Sci Med. 1999;49(1):55-66.
10. 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;16:291-296.
11. Strand LM, Cipolle RJ, Morley PC, Perrier DG.. Levels of pharmaceutical care: a needs-based approach. Am J Hosp Pharm. 1991;48(3):547-550.
12. Cordina M, Safta V, Ciobanu A, Sautenkova N. An assessment of community pharmacists’ attitudes towards professional practice in the Republic of Moldova. Pharm Pract (Internet). 2008;6(1):1-8.
13. Baldon JP, Correr CJ, Melchiors AC, Rossignoli P, Fernandez-Llimos F, Pontarolo R. Community pharmacists’ attitudes and knowledge on dispensing drugs to pregnant women. Pharm Pract (Internet). 2006;4(1):38-43.
14. Barrows HS. An overview of the uses of standardized patients for teaching and evaluating clinical skills. Acad Med. 1993;68(6):443-451.
15. ASHP guidelines on pharmacist-conducted Patient education and counseling medication therapy and Patient Care: organization and delivery of services–guidelines. 2006; 262-228.
16. Guidelines and minimum standards for good pharmacy practice (GPP) in UAE pharmacies guide to good pharmacy practice (GPP) in UAE pharmacies. 2009.9;1-5.
17. Badri AM, Hollingsworth J. A simulation model for scheduling in the emergency room. Int J Operat Product Manag. 1993;13(3):13-24.
18. Su S, Shih CL. Resource reallocation in an emergency medical service system using computer simulation. Am J Emerg Med. 2002;20(7):627-34.
19. Chua SS, Ramachandran CD, Paraidathathu TT. Response of community pharmacists to the presentation of back pain: a simulated patient study. Int J Pharm Pract.2006;14(3):171-178.
20. Darbishire PL, Plake KS, Nash CL, Shepler BM. Active-learning laboratory session to teach the four M's of diabetes care. Am J Pharm Educ. 2009;73(2):22.
21. Werner JB, Benrimoj SI. Audio taping simulated patient encounters in community pharmacy to enhance the reliability of assessments. Am J Pharm Educ. 2008;72(6):136.
22. Watson MC, Skelton JR, Bond CM, Croft P, Wiskin CM, Grimshaw JM, Mollison J. Simulated patients in the community pharmacy setting. Using simulated patients to measure practice in the community pharmacy setting. Pharm World Sci. 2004;26(1):32-37.
23. Austin Z, Gregory P, Tabak D. Simulated Patients vs. Standardized Patients in Objective Structured Clinical Examinations. Am J Pharm Educ. 2006;15;70(5):119.
24. World Health Organization: Disease and injury country estimates. 2009 http://www.who.int/healthinfo/global_burden_disease/estimates_country/ en/index.html (accessed Sep-2010)
25. Hope NH, Ray SM, Franks AS, Heidel E. Impact of an educational intervention on steroid prescribing and dosing effect on patient outcomes in COPD exacerbations. Pharm Pract (internet) 2010;8(3):162-166.
26. Gandhi TK, Weingart SN, Seger AC, Borus J, Burdick E, Poon EG, Leape LL, Bates DW. Outpatient prescribing errors and the impact of computerized prescribing. J Gen Intern Med. 2007; 20:837-841.
27. Basheti IA, Reddel HK, Armour CL, Bosnic-Anticevich SZ. Improved asthma outcomes with a simple inhaler technique intervention by community pharmacists. J Allergy Clin Immunol. 2007;119(6):1537-1538.
28. Fink JB, Rubin BK. Problems with inhaler use: a call for improved clinician and patient education. Respir Care. 2005;50(10):1360-1374.
29. Rubin BK. 2004. What does it mean when a patient says, My asthma medication is not working? Chest. 2004;126(3):972-981.
30. Stiegler KA, Yunker NS, Crouch MA. Effect of pharmacist counseling in patients hospitalized with acute exacerbation of asthma. Am J Health Syst Pharm. 2003;60(5):473-476.
31. Hollingworth W, Devine EB, Hansen RN, Lawless NM, Comstock BA, Norton JLW. The Impact of e-Prescribing on Prescriber and Staff Time in Ambulatory Care Clinics: A Time–Motion Study. J Am Med Inform Assoc. 2007;14(6):722-730.
32. Lewis RK, Lasack NL, Lambert BL, Connor SE. Patient counseling--a focus on maintenance therapy. Am J Health Syst Pharm. 1997;54(18);2084-2098.
33. Bonnabry P, Despont-Gros C, Grauser D, Casez P, Despond M, Pugin D, Rivara-Mangeat C, Koch M, Vial M, Iten A, Lovis C. A risk analysis method to evaluate the impact of a computerized provider order entry system on patient safety. J Am Med Inform Assoc. 2008;15(4):453-460.
34. Barber N, Rawlins M, Dean Franklin B.. Reducing prescribing error: competence, control, and culture. Qual Saf Health Care. 2003;12(Suppl 1):i29-32.
35. Lavorini F, Magnan A, Dubus JC, Voshaar T, Corbetta L, Broeders M, Dekhuijzen R, Sanchis J, Viejo JL, Barnes P, Corrigan C, Levy M, Crompton GK. Effect of incorrect use of dry powder inhalers on management of patients with asthma and COPD. Respir Med. 2008;102(4):593-604.
36. Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, Fukuchi Y, Jenkins C, Rodriguez-Roisin R, van Weel C, Zielinski J; Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2007;176(6):532-555.
37. Schneider CR, Everett AW, Geelhoed E, Kendall PA, Clifford RM. Measuring the assessment and counseling provided with the supply of nonprescription asthma reliever medication: a simulated patient study. Ann Pharmacother. 2009 Sep;43(9):1512-1518.
38. Hindle M, Newton DA, Chrystyn H. Investigations of an optimal inhaler technique with the use of urinary salbutamol excretion as a measure of relative bioavailability to the lung. Thorax. 1993;48(6):607-610.
39. Armour C, Bosnic-Anticevich S, Brillant M, Burton D, Emmerton L, Krass I, Saini B, Smith L, Stewart K.Pharmacy Asthma Care Program (PACP) improves outcomes for patients in the community. Thorax. 2007;62(6):496-502.
40. Hindle M, Chrystyn H. Relative bioavailability of salbutamol to the lung following inhalation using metered dose inhalation methods and spacer devices. Thorax. 1994;49(6):549-553.
41. World Health Organization: Disease and injury country estimates. 2009. (accessed Sep-2010) http://www.who.int/healthinfo/global_burden_disease/estimates_country/ en/index.html
How to Cite
Copyright (c) 0 Pharmacy Practice
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 Unported License.