Evaluating the practice of Iranian community pharmacists regarding oral contraceptive pills using simulated patients
Background: As oral contraceptive pills are available over the counter in pharmacies, pharmacists are professionally responsible for checking and informing patients about every aspect of taking these drugs. Simulated patient method is a new and robust way to evaluate professional performance of pharmacists.
Objective: The aim of the present study was to evaluate the pharmacy practice of Iranian pharmacists regarding over-the-counter use of oral contraceptive pills using simulated patient method.
Methods: Simulated patients visited pharmacy with a prescription containing ciprofloxacin and asked for oral contraceptive pills. The pharmacist was expected to ask important questions for using these drugs and to inform the patient about them properly. Moreover, the Pharmacists should advise patients in regard to the possible interaction.
Results: Ninety four pharmacists participated in this study. In 24 (25.3%) visits, the liable pharmacist was not present at the time of purchase. Furthermore, In 13 (18.57 %) visits by the simulated patients, the liable pharmacists did not pay any attention to the simulated patients even when they asked for consultation. Twenty nine (41.43%) pharmacists did not ask any question during dispensing. Nausea was the most frequent described side effect by pharmacists (27 (38.57%)). Yet important adverse effects of oral contraceptive pills were not mentioned by the pharmacists except for few ones. Only twelve (17.14%) pharmacists mentioned the possible interaction. There was a significant relation between the pharmacists’ gender and detection of possible interaction (p value= 0.048).
Conclusion: The quality of the pharmacists’ consultations regarding the over the counter use of oral contraceptive pills was not satisfactory and required improvement.
2. Stone RH, Rafie S, El-Ibiary SY, Karaoui LR, Shealy KM, Vernon VP. Oral contraceptive pills and possible adverse effects. J Symptoms Signs. 2014;3(4):282-291.
3. Obreli-Neto PR, Pereira LRL, Guidoni CM, de Oliveira Baldoni A, Marusic S, de Lyra-Júnior DP, de Almeida KL, Pazete AC, do Nascimento JD, Kos M. Use of simulated patients to evaluate combined oral contraceptive dispensing practices of community pharmacists. PLoS One. 2013;8(12):e79875. doi: 10.1371/journal.pone.0079875
4. Shortridge E, Miller K. Contraindications to oral contraceptive use among women in the United States, 1999-2001. Contraception. 2007 May;75(5):355-360 doi:10.1016/j.contraception.2006.12.022
5. Grossman D, White K, Hopkins K, Amastae J, Shedlin M, Potter JE. Contraindications to combined oral contraceptives among over-the-counter compared with prescription users. Obstet Gynecol. 2011;117(3):558-565. doi: 10.1097/AOG.0b013e31820b0244
6. Westhoff CL, Heartwell S, Edwards S, Zieman M, Stuart G, Cwiak C, Davis A, Robilotto T, Cushman L, Kalmuss D. Oral contraceptive discontinuation: do side effects matter? Am J Obstet Gynecol. 2007;196(4):412. doi:10.1016/j.ajog.2006.12.015
7. Frost JJ, Singh S, Finer LB. US Women’s One-Year Contraceptive Use Patterns, 2004. Perspect Sex Reprod Health. 2007;39(1):48-55. doi: 10.1363/3904807
8. Grossman D, Ellertson C, Abuabara K, Blanchard K, Rivas FT. Barriers to contraceptive use in product labeling and practice guidelines. Perspect Sex Reprod Health. 2007;39(1):48-55. doi: 10.2105/AJPH.2004.040774
9. Machado RrB, de Melo NR, Prota FE, Lopes GP, Megale A. Women's knowledge of health effects of oral contraceptives in five Brazilian cities. Contraception. 2012;86(6):698-703. doi: 10.1016/j.contraception.2012.05.016
10. Queddeng K, Chaar B, Williams K. Emergency contraception in Australian community pharmacies: A simulated patient study. Contraception. 2011;83(2):176-182. doi: 10.1016/j.contraception.2010.07.011
11. 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.
12. Watson MC, Cleland JA, Bond CM. Simulated patient visits with immediate feedback to improve the supply of over-the-counter medicines: a feasibility study. Fam Pract. 2009;26(6):532-542. doi: 10.1093/fampra/cmp061
13. Watson M, Norris P, Granas A. A systematic review of the use of simulated patients and pharmacy practice research. Int J Pharm Pract. 2006;14:83-93. doi: 10.1211/ijpp.14.2.0002
14. Motlaq ME, Eslami M, Yazdanpanah M, Nakhaee N. Contraceptive use and unmet need for family planning in Iran. Int J Gynaecol Obstet. 2013;121(2):157-161. doi: 10.1016/j.ijgo.2012.11.024
15. Toh S, Mitchell AA, Anderka M, de Jong-van den Berg LT, Hernández-Díaz S; National Birth Defects Prevention Study. Antibiotics and oral contraceptive failure-a case-crossover study. Contraception. 2011;83(5):418-425. doi: 10.1016/j.contraception.2010.08.020
16. Burroughs KE, Chambliss ML. Antibiotics and oral contraceptive failure. Arch Fam Med. 2000;9(1):81-82.
17. Anderson KC, Schwartz MD, Lieu SO. Antibiotics and OC effectiveness. JAAPA. 2013;26(1):11.
18. Koda-Kimble MA, Alldredge BK, Corelli RL, Ernst ME. Koda-Kimble and Young's applied therapeutics: the clinical use of drugs.10th ed. Philadelphia: Lippincott Williams & Wilkins; 2012.
19. Joint FIP/WHO guidelines on good pharmacy practice: standards for quality of pharmacy services. WHO Technical Report Series, No. 961, 2011. Geneva: World Health Organization. 2011. Available at: http://www.fip.org/www/uploads/database_file.php?id=331&table_id= (accessed February 28, 2016)
20. Brata C, Gudka S, Schneider CR, Everett A, Fisher C, Clifford RM. A review of the information-gathering process for the provision of medicines for self-medication via community pharmacies in developing countries. Res Social Adm Pharm. 2013;9(4):370-383. doi: 10.1016/j.sapharm.2012.08.001
21. Chirdan OO, Zoakah AI. Health risk screening practices of pharmacy and chemist shops in selling oral contraceptives to women in Jos Metropolis. J Med Trop. 2010;12(1):18-21. doi: 10.4314/jmt.v12i1.69306
22. Schafheutle EI, Seston EM, Hassell K. Factors influencing pharmacist performance: A review of the peer-reviewed literature. Health Policy. 2011;102(2-3):178-192. doi: 10.1016/j.healthpol.2011.06.004
23. 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;78(2):143-148. doi: 10.1016/j.pec.2009.07.012
24. 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;32(3):353-361. doi: 10.1007/s11096-010-9375-z
25. Albekairy AM. Pharmacists' Perceived Barriers to Patient Counseling. J Appl Pharm Sci. 2014;4(10):70-73. doi: 10.7324/JAPS.2014.40112
26. Brata C, Gudka S, Schneider CR, Clifford RM. A review of the provision of appropriate advice by pharmacy staff for self-medication in developing countries. Res Social Adm Pharm. 2015;11(2):136-153. doi: 10.1016/j.sapharm.2014.07.003
27. Dadfar H, Brege S. Differentiation by improving quality of services at the last touch point: the case of Tehran pharmacies. Int J Qual Serv Sci. 2012;4:345-363. doi: 10.1108/17566691211288331
28. Smith F. The quality of private pharmacy services in low and middle-income countries: a systematic review. Pharm World Sci. 2009;31(3):351-361. doi: 10.1007/s11096-009-9294-z
29. Scahill S. Barriers to effective pharmacy practice in low-and middle-income countries. Integr Pharm Res Pract. 2014;3:25-27. doi: 10.2147/IPRP.S35379
30. Schneider R, Gudka S, Fleischer L, Clifford RM. The use of a written assessment checklist for the provision of emergency contraception via community pharmacies: a simulated patient study. Pharm Pract (Granada). 2013;11(3):127-131.
31. Abbasi NM, Salamzadeh J. Evaluation of pharmacists knowledge in Tehran about emergency contraception method using HD tablets. J Med Council Iran. 2008;26:360-367.
32. Sattari M, Mokhtari Z, Jabari H, Mashayekhi S. Knowledge, attitude and practice of pharmacists and health-care workers regarding oral contraceptives correct usage, side-effects and contraindications. East Mediterr Health J. 2013;19(6):547-554.
33. 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. doi: 10.1016/j.contraception.2006.07.006
34. Grossman D, Grindlay K, Li R, Potter JE, Trussell J, Blanchard K. Interest in over-the-counter access to oral contraceptives among women in the United States. Contraception. 2013;88(4):544-552. doi: 10.1016/j.contraception.2013.04.005
35. Smith L, Whitfield MJ. Women's knowledge of taking oral contraceptive pills correctly and of emergency contraception: effect of providing information leaflets in general practice. Br J Gen Pract. 1995;45(397):409-414.
36. Raymond EG, Chen PL, Dalebout SM. "Actual Use" Study of Emergency Contraceptive Pills Provided in a Simulated Over-the-Counter Manner. Obstet Gynecol. 2003 Jul;102(1):17-23.
37. Salamzadeh J. Clinical pharmacy in Iran: where do we stand? Iran J Pharm Res. 2004;3:1-2.
38. James D, Nastasic S, Davies J, Horne R. The design and evaluation of a simulated-patient teaching programme to develop the consultation skills of undergraduate pharmacy students. Pharm World Sci. 2001 Dec;23(6):212-216.
39. Wallman A, Vaudan C, Sporrong SKl. Communications training in pharmacy education, 1995-2010. Am J Pharm Educ. 2013;77(2):36. doi: 10.5688/ajpe77236
The authors hereby transfer, assign, or otherwise convey to Pharmacy Practice: (1) the right to grant permission to republish or reprint the stated material, in whole or in part, without a fee; (2) the right to print pr epublish copies for free distribution or sale; and (3) the right to republish the stated material in any format (electronic or printed). In addition, the undersigned affirms that the article described above has not previously been published, in whole or part, is not subject to copyright or other rights except by the author(s), and has not been submitted for publication elsewhere, except as communicated in writing to Pharmacy Practice with this document.
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC-BY-NC-ND) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Author Self-Archiving Policy
Pharmacy Practice permits and encourages authors to post and archive the final pdf of the articles submitted to the journal on personal websites or institutional repositories after publication, while providing bibliographic details that credit its publication in this journal.