Evaluating community pharmacy practice in Qatar using simulated patient method: acute gastroenteritis management
Objective: To evaluate Qatari pharmacists’ prescribing, labeling, dispensing and counseling practices in response to acute community-acquired gastroenteritis.
Methods: The simulated patient method was used in this study. Thirty pharmacies in Doha were randomly selected and further randomized into two groups: Face-to-Face (n=15) vs. Telephone-call (n=15) per simulated patient; 2 simulated patients were involved. Prescribing, labeling, dispensing and counseling practices were assessed. Data analysis was performed using Mann-Whitney and chi square tests at alpha=0.05.
Results: Most pharmacists prescribed and dispensed medicines (96%), including antimicrobials (43.9%), antidiarrheals (36%), antiemetics (5.1%) and antipyretics (3%). Counseling practices were poor (62.1% in the face-to-face group vs 70% in the telephone-call group did not counsel simulated patients about the dispensed medicines; p-value=0.50). In more than one-third of the encounters, at least one labeling parameter was missing. The duration of each interaction in minutes was not significantly different between the groups [median (IQR); 3(4.25) in the face-to-face group versus 2(0.25) in the telephone-call group; p-value=0.77]. No significant differences in prescribing or dispensing behaviors were present between groups (p-value>0.05).
Conclusion: Qatar community pharmacists’ labeling, dispensing, and counseling practices were below expectation, thus urging the need for continuous professional development.
2. Laliberté MC, Perreault S, Damestoy N, Lalonde L. Ideal and actual involvement of community pharmacists in health promotion and prevention: a cross-sectional study in Quebec, Canada. BMC Public Health. 2012;12:192. doi: 10.1186/1471-2458-12-192
3. National Health Strategy 2011-2016. 2014 General Secretariat, Supreme Council of Health. Available at http://www.nhsq.info/app/media/1541 (accessed 29 March 2016).
4. Nga do TT, Chuc NT, Hoa NP, Hoa NQ, Nguyen NT, Loan HT, Toan TK, Phuc HD, Horby P, Van Yen N, Van Kinh N, Wertheim HF. Antibiotic sales in rural and urban pharmacies in northern Vietnam: an observational study. BMC Pharmacol Toxicol. 2014;15:6. doi: 10.1186/2050-6511-15-6
5. Kotwani A, Wattal C, Joshi PC, Holloway K. Irrational use of antibiotics and role of the pharmacist: an insight from a qualitative study in New Delhi, India. J Clin Pharm Ther. 2012;37(3):308-312. doi: 10.1111/j.1365-2710.2011.01293.x
6. Gastelurrutia MA, Larrañaga B, Garay A, Echeveste Fde A, Fernandez-Llimos F. Impact of a program to reduce the dispensing of antibiotics without a prescription in Spain. Pharm Pract (Granada). 2013;11(4):185-190.
7. Kheir N, Fahey M. Pharmacy practice in Qatar: challenges and opportunities. South Med Rev. 2011;4(2):92-96. doi: 10.5655/smr.v4i2.1007
8. El Hajj MS, Salem S, Mansoor H . Public’s attitudes towards community pharmacy in Qatar: a pilot study. Patient Prefer Adherence. 2011;5:405-422. doi: 10.2147/PPA.S22117
9. Viral gastroenteritis. Medline Plus. US National Library of Medicine. Available at: https://www.nlm.nih.gov/medlineplus/ency/article/000252.htm (accessed 28 October 2015).
10. Tablang MVF, Wu GY. Viral gasteroenteritis. Available at: http://emedicine.medscape.com/article/176515-overview (accessed 28 October 2015).
11. Qatar National Vision http://www.qu.edu.qa/pharmacy/components/upcoming_events_material/Qatar_National_Vision_2030.pdf (accessed 28 March 2016).
12. Diwan V, Sabde YD, Byström E, De Costa A. Treatment of pediatric diarrhea: a simulated client study at private pharmacies of Ujjain, Madhya Pradesh, India. J Infect Dev Ctries. 2015;9(5):505-511. doi: 10.3855/jidc.5694
13. da Rocha CE, Bispo ML, dos Santos AC, Mesquita AR, Brito GC, de Lyra DP Jr. Assessment of community pharmacists' counseling practices with simulated patients who have minor illness: a pilot study. Simul Healthc. 2015;10(4):227-238. doi: 10.1097/SIH.0000000000000100
14. 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.
15. Teinilä T, Halmepuro-Jaatinen S, Yritys K, Manni K, Airaksinen M. Adapting the US Institute for Safe Medication Practices' medication safety self-assessment tool for community pharmacies in Finland. Int J Pharm Pract. 2012;20(1):15-24. doi: 10.1111/j.2042-7174.2011.00158.x
16. Dameh M. Pharmacy in the United Arab Emirates. South Med Rev. 2009;2(1):15-18.
17. Kheir N, Zaidan M, Younes H, El Hajj M, Wilbur K, Jewesson PJ. Pharmacy education and practice in 13 middle eastern countries. Am J Pharm Educ. 2008;72(6):133.
18. Basheti IA, Qunaibi EA, Hamadi SA, Abu-Gharbieh E, Saleh S, AbuRuz S, Mohamoud M, Bulatova NR. Patient perspectives of the role of the community pharmacist in the Middle East: Jordan, United Arab Emirates and Iraq. Pharmacol Pharm. 2014;5: 588-599. doi: 10.4236/pp.2014.56069
19. WHO. The role of the pharmacist in self-care and self-medication, 1998 report of the 4th WHO consultative group on the role of the pharmacist. The Hague: WHO; 1998
20. Dayani G, de Mattos GL, Modolon AG, Cristina TS. Responsible self-medication: review of the process of pharmaceutical attendance. Braz J Pharm Sci. 2004;45(4):625-633. doi: 10.1590/S1984-82502009000400004
21. Wilbur K, Salam SE, Mohammadi E. Patient perceptions of pharmacist roles in guiding self-medication of over-the-counter therapy in Qatar. Patient Prefer Adherence. 2010;4:87-93.
22. Huntington D, Schuler SR. The simulated client method: evaluating client-provider interactions in family planning clinics. Stud Fam Plann. 1993;24(3):187-193.
23. How to study medicines use in communities. World Health Organization, 2004, WHO/EDM/PAR/2004.2. Available at: http://whqlibdoc.who.int/hq/2004/WHO_EDM_PAR_2004.2.pdf (accessed 28 October 2015).
24. Puspitasari HP, Aslani P, Krass I. A review of counseling practices on prescription medicines in community pharmacies. Res Social Adm Pharm. 2009;5(3):197-210. doi: 10.1016/j.sapharm.2008.08.006
25. Madden JM, Quick JD, Ross-Degnan D, Kafle KK. Undercover Careseekers: simulated clients in the study of health provider behavior in developing countries. International Conferences on Improving Use of medicines. Available at: http://archives.who.int/icium/icium1997/posters/1b4_text.html (accessed 18 March 2016).
26. Alabid AH, Ibrahim MI, Hassali MA. Antibiotics dispensing for URTIs by community pharmacists (CPs) and general medical practitioners in Penang, Malaysia: A comparative study using simulated patients (SPs). J Clin Diagn Res. 2014;8(1):119-123. doi: 10.7860/JCDR/2014/6199.3923
27. Ogbo PU, Aina BA, Aderemi-Williams R. Management of acute diarrhea in children by community pharmacists in Lagos, Nigeria. Pharm Pract (Granada). 2014;12(1):376
28. 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
29. Smith F. Private local pharmacies in low- and middle-income countries: a review of interventions to enhance their role in public health. Trop Med Int Health. 2009;14(3):362-372. doi: 10.1111/j.1365-3156.2009.02232.x
30. 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
31. Institute for Safe Medication Practices. Principles of designing a medication label for community and mail order pharmacy prescription packages. Available at: http://www.ismp.org/tools/guidelines/labelFormats/comments/printerVersion.pdf (accessed 29 March 2016).
32. Alkhani S, Ahmed Y, Bin-Sabbar N, Almogirah H, Alturki A, Albanyan H, Adam M, Saleem F, Aljadhey H, Hassali MA, Vaida AJ. Current practices for labeling medications in hospitals in Riyadh, Saudi Arabia. Saudi Pharm J. 2013;21(4):345-349. doi: 10.1016/j.jsps.2012.12.002
33. American Society of Health-System Pharmacists. ASHP guidelines on pharmacist-conducted patient education and counseling. Am J Health Syst Pharm. 1997;54(4):431-434.
34. Barr W, Smith A. Acute diarrhea in adults. Am Fam Physician. 2014;89(3):180-189.
35. Sabry NA, Farid SF, Dawoud DM. Antibiotic dispensing in Egyptian community pharmacies: an observational study. Res Social Adm Pharm. 2014;10(1):168-184. doi: 10.1016/j.sapharm.2013.03.004
36. Farah R, Lahoud N, Salameh P, Saleh N. Antibiotic dispensation by Lebanese pharmacists: a comparison of higher and lower socio-economic levels. J Infect Public Health. 2015;8(1):37-46. doi: 10.1016/j.jiph.2014.07.003
37. Hounsa A, De Mol P. Antibiotics dispensed upon the recommendation of staff in private dispensaries in Abidjan in the Ivory Coast. J Pharm Belg. 2009;(3):99-104.
38. Albekairy AM. Pharmacists’ perceived barriers to patient counseling. J Appl Pharm Sci. 2014;4(1):70-73. doi: 10.7324/JAPS.2014.40112
39. Oh Y, McCombs JS, Cheng RA, Johnson KA. Pharmacist time requirements for counseling in an outpatient pharmacy. Am J Health Syst Pharm. 2002;59(23):2346-2355.