Utilization of simulated patients to assess diabetes and asthma counseling practices among community pharmacists in Qatar

Role of pharmacists in the care of adult asthma patients: A scoping review

BACKGROUND

Asthma is a common long-term condition that affects people of all ages. Evidence suggests that a significant proportion of asthma patients in the Gulf Cooperation Council (GCC) do not receive appropriate diagnosis, monitoring and/or treatment. When inadequately treated, asthma can negatively affect quality of life and may lead to hospitalisation and death. Although pharmacists play a role in asthma care globally, there appears to be no defined role for pharmacists in providing care to patients with asthma in the GCC countries.

AIM

This scoping review aims to review and summarise studies conducted in the GCC countries involving pharmacists in the management of adults with asthma or evaluating pharmacists' asthma care knowledge and/or skills.

METHOD

A systematic scoping review was undertaken. Seven databases were searched using relevant search terms for articles published up to May 2023. Studies that evaluated pharmacists roles, knowledge and skills in providing asthma care to adults in the United Arab Emirates (UAE), Qatar, Kuwait, Oman, Saudi Arabia, and Bahrain were considered eligible for inclusion. Extracted data were collated using tables and used to produce narrative descriptive summaries.

RESULTS

Out of the 1588 search results, only seven studies met the inclusion criteria. Of those, only one developed and tested a pharmacist-led inhaler technique educational intervention in the UAE within community pharmacy setting for asthma patients. The remaining six studies assessed community pharmacists knowledge in providing asthma management and patient education in UAE, Saudi Arabia and Qatar. The quality of the included studies varied with four relying on simulated patients to assess pharmacists knowledge. The study that tested the intervention suggested improvement in inhaler technique and asthma symptoms control after receiving the intervention. The findings suggest a need to improve pharmacists knowledge of inhaler technique demonstration (mainly Metered Dose Inhalers), asthma management advice and assessment of asthma control and medication use.

CONCLUSION

This review highlights a lack of research on pharmacist-led asthma interventions and identifies training needs to enable pharmacists to be involved in asthma care in the GCC countries. Future research could develop approaches involving pharmacists to improve asthma care and outcomes in the region.

Opportunities for Community Pharmacists to Counsel Patients With Epilepsy and Seizure Clusters to Overcome Barriers and Foster Appropriate Treatment

Some patients with epilepsy experience seizure clusters, which may be defined as 2 or more seizures occurring within 24 hours. Left untreated, seizure clusters increase the risk for physical injury and may progress to status epilepticus, irreversible neurologic injury, and death. Rescue therapy is based on benzodiazepine treatment. Prompt, appropriate use should be specified in patients' individualized seizure action plans. Most seizure clusters occur outside the hospital setting. The ideal rescue therapy allows for easy and quick administration by a nonmedical person, which may minimize the need for intervention by emergency medical personnel or transportation to the hospital. In the 2 decades before the approval of 2 intranasal benzodiazepines in 2019 and 2020, rectal diazepam was the only route of administration approved by the US Food and Drug Administration specifically for seizure clusters. Each of the approved intranasal formulations has a unique profile. Both offer a convenient and socially acceptable route of administration. Recognition of seizure clusters and timing of proper administration are key to successful use of rescue therapy. Pharmacists' counseling plays an important role in reinforcing when and how to appropriately administer rescue therapies and the importance of consistently using rescue treatment when indicated to promote effective management. This review includes resources for pharmacists, patients, and caregivers; reviews currently available treatments; and discusses seizure action plans that support effective treatment of seizure clusters.

Role of Community Pharmacist in Asthma Management: Knowledge, Attitudes and Practice

Purpose

To investigate knowledge, attitude, and practice of asthma management counseling and the perceived barriers by community pharmacists.

Methods

This cross-sectional study was conducted on 416 community pharmacists using an online-based questionnaire. The questionnaire included five parts that assessed socio-demographics and medical references used to seek drug-related information, pharmacists' knowledge (7 items), attitudes (5 items), practice (22 items) and the barriers for the provision of asthma management counseling (10 items). Binary logistic regression was conducted to find the variables that were significantly and independently associated with knowledge, attitude and asthma management counseling practice.

Results

Increased years of experience was associated with decreased knowledge (OR = 0.918, 95% Cl (0.869:0.970), P = 0.002) and less positive attitude toward asthma management (OR = 0.876, 95% Cl. (0.821:0.935), P < 0.001), while working in independent community pharmacy (OR = 2.097, 95% Cl. (1.273:3.454), P = 0.004) and increased awareness of asthma management guidelines (OR = 1.60, 95% CI. (1.044:2.453), P = 0.031) increased the odds of being in the high knowledge group. In contrast, increasing the daily number of pharmacy visitors OR = 1.009, 95% Cl. (1.001:1.016), P = 0.024) and having a pharmacy degree (OR = 2.330, 95% Cl. (1.256:4.326), P = 0.007) increased the odds of having a positive attitude. Male pharmacists (OR = 0.553, 95% Cl. (0.350:0.873), P = 0.011) and having bachelor in pharmacy (OR = 0.354, 95% Cl. (0.179:0.700), P = 0.003) decreased the odds of being in the high practice group. On the other hand, increased awareness of asthma management guidelines tripled the odds of being in the high practice group (OR = 3.067, 95% Cl. (1.964:4.787), P < 0.001).

Conclusion

The current study findings offer valuable insights into the gaps in knowledge, attitude, and practice of asthma management counseling among community pharmacists, as well as the barriers and factors that impede the provision of these services. These insights serve as a guide for developing future strategies aimed at enhancing the role of pharmacists in asthma care.

Simulation video: a tool to evaluate communications skills in radiologist residents

BACKGROUND

Effective communication is a crucial component of radiology resident training, and many different aspects need to be explored when teaching and evaluating communication skills. To ensure that radiology residents' communication skill levels can be measured accurately, a standardized evaluation tool has been introduced. In twenty hospitals in Beijing, simulation videos have been developed as a way to assess the communication skills of radiology residents during their certification exams, to minimize evaluating biases. This study aims to assess the performance of a simulation video model in evaluating communications skills compared to the standard patient model.

METHODS

This is a retrospective observational study. The performance of standard patient and simulation video models was evaluated through an eight-year examination of communication skills in radiology residents. From 2014 to 2021, communications skill tests were administered to 1003 radiology residents in 20 hospitals in Beijing. The standardized patient (SP) model was applied in 2014, and simulation videos were used from 2015 to 2021. The difficulty and discrimination radio of the tests were evaluated. The subjective survey for candidates on two models of communication skills evaluation was performed and analyzed.

RESULTS

The simulation video model evaluation demonstrated stable difficulty (ranging from 0.92 to 0.98) and discrimination ratio (ranging from 0.37 to 0.49), except for minor exceptions of discrimination in 2019 (0.58) and 2020 (0.20). Furthermore, the Kruskal-Wallis H test revealed no significant differences in average scores between 2016 (93.9 ± 4.6) and 2018 (94.5 ± 4.2), 2016 and 2019 (97.3 ± 3.9), 2017 (97.0 ± 5.6) and 2019, 2017 and 2020 (97.7 ± 4.7), as well as 2019 and 2020 exams (all p ≥ 0.05). In addition, candidates who responded to the survey preferred the simulation video model (with a 77.2% response rate), with 62.7% choosing it over the SP model for communication skills evaluation.

CONCLUSION

The simulation video demonstrated a stable and better acceptable construct for assessing radiology residents' communication skills.

Evaluation of pharmacist's practices regarding the antimicrobials dispensing: a simulated patient study

BACKGROUND

The indiscriminate use of antimicrobials is considered a major contributing factor to the increase in antimicrobial resistance. Community pharmacies are the main source of access to antimicrobials, and pharmacists are in a strategic position to promote rational use of these medicines. Therefore, it is important to know dispensing service quality.

OBJECTIVE

To evaluate the behavior of pharmacists in dispensing antimicrobials in community pharmacies in northeast Brazil.

METHODS

This cross-sectional pilot study was conducted from August to October 2021 in a private community pharmacy chain in Sergipe. Dispensing was evaluated using the simulated patient (SP) technique. Two SP asked the pharmacists for the antimicrobials (case clinic 1: upper respiratory infection; case clinic 2: urinary tract infection) and recorded the service through audio. Dispensing practices were independently analyzed by two researchers based on the tools available in the literature. Data were presented using descriptive statistics.

RESULTS

A total of 54 simulated patient visits were conducted. Based on the 12 steps recommended by the research team for good dispensing, pharmacists asked an average of 1 (±1.17) question for upper respiratory infections and 0.3 (±0.54) for urinary tract infections, as well as provided counseling (mean number of recommendations, 2.6 (±1.44) and 4.5 (±2.35), respectively). As for communication skills, pharmacists had a regular score (3.07 ± 0.34). Furthermore, there was no significant difference in the number of steps and counseling recommendations by pharmacists in dispensing clinical cases 1 and 2 (p = 0.0674).

CONCLUSION

The quality of antimicrobial dispensing was evaluated as suboptimal, requiring improvements in practice and multifaceted strategies to promote continuing education of these professionals. In addition, awareness actions for the population must be implemented to promote the rational use of antimicrobials and reduce microbial resistance.

Critical appraisal of simulated patient methodology to assess the practice of community pharmacist in the Middle East and North Africa region: A systematic review

Background

The use of simulated patient (SP) methodology in pharmacy practice settings has increased recently. However, its applications can vary significantly within a region, hence affecting the quality of the SP methodology.

Objective

The purpose of this systematic review is to critically assess the use of the SP methodology for assessing the practice of community pharmacists (CP) in the Middle East and North Africa (MENA) region.

Methods

A comprehensive literature search was conducted using EMBASE, MEDLINE, ProQuest, and SCOPUS to identify articles published from 2011 to 2022. The selection of relevant studies for inclusion in the systematic review was based on the pre-determined inclusion criteria. The Mixed Method Appraisal Tool (MMAT) was used to assess the methodological quality of the included studies.

Results

Electronic search yielded 478 publications. A total of 45 studies were reviewed. The studies were conducted in 12 countries of the MENA region. The sample size between the reviewed articles ranged from 20 to 1000 (median= 129). A greater number of the included studies measured the adequacy of skill (pre-dispensing and/or post-dispensing) 38 (84.4%). The vast majority of the studies reported unsatisfactory results regarding the competencies of CP. The number of the SP ranged from 1 to 37 (median= 2). Most of the studies recruited only one SP per pharmacy 35 (77.8%). The most common data collection method was written data collection form 42 (93.3%). Few studies only had a detection system for SP visits 11 (24.4%), and only six studies incorporated performance feedback (13.3%). More than two-thirds of the studies provided a training session for SP 37 (82.2%). There was variation in the symptoms and drugs used in the SP scenarios in the studies.

Conclusion

Although the results demonstrate the growth in the use of the SP method in MENA region countries, studies showed high variability in the level of reporting the study methodology. Consequently, we argue the need for standardized reporting of these studies.

Knowledge, attitude, and practice of pharmacists regarding asthma management: a cross-sectional study in Egypt

Background

Asthma is a significant public health issue that poses a substantial health and economic burden. Despite the availability of effective asthma medications, its management remain suboptimal. Recent asthma guidelines have highlighted the importance of pharmacist unique position and its interventional strategies in positively impacting asthma treatment outcomes. Therefore, this study aimed to assess the degree of Egyptian pharmacists’ knowledge, attitudes, as well as their practices towards asthma management in line with the recent asthma guidelines.

Methods

This cross-sectional study was conducted among 800 pharmacists working in different private and governmental sectors. The data were collected using a 37-item pre-validated self-administered KAP questionnaire. The data were analyzed using Student’s t-test and analysis of variance to assess the association between each KAP level and the sociodemographic variables at the significance level of 0.05.

Results

Of the 800 distributed questionnaire, a total of 550 participants (316 Male, and 234 Female) responded, representing a 68.7% response rate. The mean ± SD score of knowledge, attitude, practice, and barrier was 5.49 ± 1.65 (min = 0; max = 8), 23.5 ± 2.84 (min = 15, max = 30), 43.12 ± 8.61 (min = 28, max = 62), and 27.76 ± 3.72 (min = 17, max = 39), respectively. The results showed that poor knowledge, attitude, and practice scores were achieved by 30.54, 0, and 38.72% of participants, respectively.

Conclusion

Our findings revealed the inconsistencies between poor pharmacists’ knowledge and practices with respect to their positive attitudes. The lack of pharmacists’ knowledge and compliance to recent GINA guidelines in this study highlight the crucial need for effective Educational strategies that should better equip pharmacists for their potential role in asthma care.

The Quality of Counseling for Headache OTC Medications in German Community Pharmacies Using a Simulated Patient Approach: Are There Differences between Self-Purchase and Purchase for a Third Party?

Background

In Germany-as worldwide-headache is one of the most frequent causes of self-medication. The dispensing of over-the-counter (OTC) medications may only be carried out by community pharmacies (CPs). In doing so, CPs have to ensure "adequate" counseling, for both self-purchase and purchase for a third party, which also occurs in everyday pharmacy practice. The aim of this study was to evaluate the quality of counseling for headache OTC medications in German CPs and, as the first study worldwide, to analyze whether and to what extent there are differences in counseling between self-purchase and purchase for a third party.

Methods

A cross-sectional study was carried out using the covert simulated patient methodology (SPM) in all 42 CPs in the German big city Potsdam. With the help of 8 trained simulated patients (SPs), each CP was visited four times by a different SP. The SPs simulated in each CP two scenarios two times with the demand for an OTC medication against headache, which differed only in whether the demand was for themselves or for their boyfriend/girlfriend.

Results

All 168 planned pharmacy visits (84 visits per scenario) were successfully carried out. Overall, the median counseling score was 3.0 out of 9 points (interquartile range [IQR 2.0]). There were no significant differences between the two scenarios (Wilcoxon signed-rank test; p=0.495, r = 0.053). In a multivariate binary logistic regression analysis, the counseling level and the different scenarios were not significantly associated (adjusted odds ratio [AOR] = 1.635, 95% CI = 0.673-3.972, p=0.278).

Conclusions

Due to the partly considerable deficits in counseling of German CPs, policy-makers and the regional chambers of pharmacists are called upon to take appropriate measures to improve the quality of counseling. It is positive that no differences in counseling between self-purchase and purchase for a third party were found, but further verifying studies with a modified methodology are recommended.

Feasibility of using simulated patients for onsite structured practice feedback in Jordanian community pharmacy settings

Simulated patient (SP) visits followed with structured feedback is useful to outline training needs as well as preference for continuing professional education in community pharmacy settings. This study aimed to investigate community pharmacists' management of an over-the-counter (OTC) product request and feasibility of immediate SP feedback in Jordan. Four trained SP visited a sample of pharmacies in three main urban cities in Jordan requesting an antacid. Information request and professional behavior as well as content of information were evaluated. The SP provided structured immediate feedback. The pharmacy staff views on the visit and usefulness of the feedback were collected. A total of 57 visits were conducted. The average duration of SP visits was 1.55 min. The average score (±SD) for information seeking behavior was 16% (±7) and for professional behavior was 56% (±15). The average score for information provision provided spontaneously was 17.1% (±12). Upon demand by the SP; the average score for information improved to 47.6 (±18). Non-pharmacological advice was not offered often; only 6 (10.5%) visits. Written information was provided in 10 (17.5%) visits. Immediate feedback was accepted by all visited pharmacies. Participants expressed positive views about the SP visit and usefulness of the feedback. Community pharmacists supplied OTC drug without carful screening of symptoms and essential information. The SP approach with immediate feedback was shown feasible and well accepted. Further potential for use of SP with feedback formally in practice and professional development should be explored in future studies.

Drug therapy-related problem management in Nigeria community pharmacy - process evaluation with simulated patient

BACKGROUND

Unresolved drug therapy-related problems (DTRPs) have economic and clinical consequences and are common causes of patients' morbidity and mortality. This study evaluated the ability of community pharmacists to identify and resolve DTRPs and assessed the perceived barriers to DTRP identification and resolution.

METHODS

A cross-sectional study which employed the use of three simulated patients (SPs) visit to 36 selected community pharmacies in 11 local government areas in Ibadan, Nigeria. The SPs played the role of a patient with prescription for multiple ailments (23-year-old male), type 2 diabetes and hypertensive patient with medication packs (45-year-old male) and hypertensive patient with gastric ulcer with a prescription (37-year-old female). They re-enacted three rehearsed vignettes when they spoke with the pharmacists. A five-member panel of experts predetermined the DTRPs present in the vignettes (n = 11), actions to take to investigate the DTRPs (n = 9) and recommendations to resolve the DTRPs (n = 9). Pharmacists' perceived barriers to the identification and resolution of DTRPs were assessed with a self-administered questionnaire. The percentage ability to detect and resolve DTRPs was determined and classified as poor ability (≤30%), fair ability (> 30 - ≤50%), moderate ability (> 50 - ≤70%) and high ability (> 70%).

RESULTS

One hundred and eight visits were made by the three SPs to the pharmacies. In total, 4.42/11 (40.2%) DTRPs were identified, 3.50/9 (38.9%) actions were taken, and 3.94/9 (43.8%) recommendations were made to resolve the identified DTRPs. The percentage ability of the community pharmacists to detect and resolve DTRPs varied slightly from one vignette to another (vignette 1-49.3%, vignette 2-39.1%, vignette 3-38.8%). But overall, it was fair (40.9%). Pharmacists' perceived barriers to DTRP detection and resolution included lack of access to patient's/client's medical history and lack of software for DTRP detection.

CONCLUSIONS

The community pharmacists displayed fair ability in detecting and resolving DTRPs. Several barriers preventing the optimal performance of pharmacist in DTRP identification and resolution were identified including inaccessibility of patient's/client's medical history. The regulatory authority of pharmacy education and practice in Nigeria need to mount Continuing Education Program to address this deficit among community pharmacists.

The role of community pharmacists in depression management: a survey of attitudes, practices and perceived barriers

Background Community pharmacists play a significant role in depression care. Depression is a health priority in national health strategies around the world, including in Qatar. Objective To describe current practices, attitudes and perceived barriers of community pharmacists towards depression care, and to investigate factors associated with these practices. Setting Community pharmacies in Qatar. Method A cross-sectional online survey using an adapted survey instrument. Scores were measured on a five-point Likert scale. Descriptive univariate and bivariate analyses of study outcomes, followed by multivariate regression examining the association between pharmacists' practices and their attitudes, socio-demographic and professional characteristics. Main outcome measure Pharmacists' scores on self-reported attitudes towards depression and depression care practices and the number of perceived barriers for depression care. Result: 358 pharmacists (response rate 39%) completed the questionnaire. Pharmacists' attitudes to depression were moderately positive (mean score = 3.41, SD = 0.26) but involvement in depression care was very low (mean score = 2.64, SD = 0.94). Three major barriers were lack of access to patients' medical records (83.21%), lack of patients' insight on depression and the importance of treatment (81.85%), and lack of knowledge and training on mental health (79.63%). Female pharmacists and those graduated more than 10 years prior were significantly less involved in depression care compared to their counterparts (practice scores (95% CI) -4.36 (-7.46 to -1.26) and -7.51 (-15.10 to -1.35), respectively), while those who had access to private counselling area were more involved (practice score 3.39 (0.20 to 6.59). Pharmacists' depression practice score was positively associated with attitudes (p = 0.001). Conclusion Pharmacists' moderately positive attitudes were not reflected in their suboptimal depression-care practices. Action from policymakers is needed to improve pharmacists' practices and attitudes to depression.

A Nationwide Mystery Caller Evaluation of Oral Emergency Contraception Practices from German Community Pharmacies: An Observational Study Protocol

To prevent unwanted pregnancies, oral emergency contraception (EC) with the active ingredients levonorgestrel (LNG) and ulipristal acetate (UPA) is recommended by the guidelines of the German Federal Chamber of Pharmacists (BAK). In this respect, community pharmacies (CPs) in Germany have a major responsibility for information gathering, selecting the appropriate medicine, availability and pricing, among other things. Therefore, it would be appropriate to conduct a study with the aim of investigating information gathering, a possible recommendation as well as availability and pricing for oral EC in German CPs. A representative nationwide observational study based on the simulated patient methodology (SPM) in the form of covert mystery calls will be conducted in a random sample of German CPs stratified according to the 16 federal states. Each selected CP will be randomly called once successfully by one of six both female and male trained mystery callers (MCs). The MCs will simulate a product-based scenario using the request for oral EC. For quality assurance of the data collection, a second observer accompanying the MC is planned. After all mystery calls have been made, each CP will receive written, pharmacy-specific performance feedback. The only national SPM study on oral EC to date has identified deficits in the provision of self-medication consultations with the help of visits in the CPs studied. International studies suggest that UPA in particular is not always available. Significant price differences could be found analogous to another German study for a different indication.

Counselling practices in an East Javan district, Indonesia: what information is commonly gathered by pharmacy staff?

Counselling by pharmacy staff plays a key role in ensuring the quality use of medications in community settings. Information gathering is the first step and an essential part of counselling. Yet, data on information gathering during counselling in Indonesia is lacking.

Objective

To identify pharmacy staff’s practice of counselling and information gathered during counselling in an East Javan district, Indonesia.

Methods

A survey questionnaire was conducted in community-based health facilities in the district (i.e. 3 hospital outpatient clinics, 69 community pharmacies and 24 Community Health Centres [CHCs]); one health facility was represented by one pharmacy staff. Quantitative content analysis was used to summarise data regarding information gathering.

Key findings

Sixty-six pharmacy staff responded, giving a 69% response rate. Almost all staff reported providing counselling; those at CHCs and outpatient clinics mostly provided prescription medicine counselling (95.5% and 100.0%, respectively), while those at community pharmacies mostly provided non-prescription medicine counselling (symptom-based versus product-based requests: 94.9% versus 71.8%, respectively). For non-prescription counselling, the most frequent information gathered was details of symptoms (symptoms-based versus product-based requests: 97.3% versus 75.0%, respectively). While for prescription medication counseling, pharmacy staff mostly asked the patient’s identity (76.2%). Less than 20% of the pharmacy staff for non-prescription/prescription medication counselling gathered information on concurrent medications or history of allergies or adverse drug reactions.

Conclusions

Pharmacy staff in these Indonesian settings provided prescription/non-prescription counselling to some extent. Improved information gathering skills are required for effective counselling, especially for prescription medications, thus ensuring rational drug use among Indonesians.

Patient Safety Culture in Handling Prescriptions and Interprofessional Collaboration Practices Amongst Community Pharmacists: An Investigative Simulated Patient Study from the United Arab Emirates

Background

Community pharmacists are in a unique position to identify drug therapy-related problems (DTRPs) in prescriptions and mitigate them by communicating with prescriber. This study assessed the ability of community pharmacists (CPs) to identify DTRPs in prescriptions, the level of interprofessional collaboration among physician and CPs in mitigating the identified DTRPs, and the existing safety culture practices among CPs.

Methods

Trained simulated patients (SPs), five final-year BSc Pharm female students, visited conveniently selected community pharmacies (n = 50) in Ajman emirate of the United Arab Emirates, with dummy prescriptions containing DTRPs (total 50 prescriptions with five different types of DTRPs categorized per the Pharmaceutical Care Network Europe Version 8) and assessed the DTRP-identifying ability of the CPs. SPs also observed the steps taken by the CPs to mitigate identified DTRPs and existing (if any) collaborative practices between CPs and physician. SPs documented their observations in a checklist immediately after leaving the pharmacy premises, which served as the data source. Statistical analyses were performed with chi-square at alpha = 0.05.

Results

Of the 50 respondents, 44% (n = 22) were able to identify the DTRPs. DTRP identification by pharmacists was associated with labeling [chi-square = 7.879, p value = 0.019], reconciliation [chi-square = 10.359, p value = 0.001], counseling standard [chi-square = 19.09, p = 0.000] and physician visit suggestion [chi-square = 31.15, p = 0.000]. The labeling standards for prescriptions with DTRPs were “low” in five (50%), “average“ in three (30%) and “good” in two (20%) of the cases with wrong dose. Average counseling time of the CPs was 80.38 ± 71.61 seconds. The counseling standard had no significant association with counseling time [chi-square = 34.79, p = 0.250] and use of drug information sources [chi-square = 2.86, p = 0.243]. Average time spent in dispensing is 74.4 ± 73.05 seconds. None (n = 0) of the CPs communicated with the physician, and only five out of 50 (10%) of CPs checked any DI sources. However, in 19 (38%) cases, the CPs recommended the SPs to consult their physician prior to taking the medications.

Conclusion

CPs were generally able to identify DTRPs and mitigate DTRPs by recommending physician consultation. Nevertheless, there were no professional collaborations between the SPs and physicians. The dispensing and counseling standards were not appreciable.

Evaluation of simulated drug dispensing and patient counseling in the course of pharmaceutical improvement: 2009 to 2015

Background

Aiming to facilitate the drug dispensing process and patient counseling, specific professional skills are required. The knowledge, skills and attitudes involved in this process can be improved. From 2012 to 2015, a nationwide course was held, in partnership with the Ministry of Health and the Federal University of Rio Grande do Sul (UFRGS) - Brazil, to train pharmacists working in primary health care through the development of their clinical and communication skills. One of the steps in this process involved the simulation of the drug dispensing process and patient counseling.

Objective

To evaluate the performance of pharmacists in drug dispensing and counseling through patient simulation role-playing held in a face-to-face meeting at the end of a training course.

Methods

A cross-sectional and retrospective study with analysis of patient simulation recordings and data collection using an assessment instrument with scores ranging from 0 to 10 points to assess pharmacist's behavior, skills, and technical knowledge.

Results

Participants presented poor-to-regular performance, with median scores equal to or lower than six. The median time of the drug dispensing simulation was five minutes and the patient counseling was eight minutes. Pharmacists had better scores in the simulation of asthma cases. In drug dispensing, 99.5% of pharmacists had difficulty checking the patient's time availability, 98.5% did not know how to use the devices, and 94.7% did not advise the patient on what to do if they forgot to take a dose. In patient counseling simulation, 1.18% of pharmacists remembered to advise on what do with medication leftovers, and 50.6% asked questions that induced the patient's responses.

Conclusions

The low-to-regular performance showed that pharmacists had difficulties at improving their skills in the performance of complete and effective drug dispensing and patient counseling.

Continuing Professional Development Needs of Community Pharmacists in Qatar: A Mixed-Methods Approach

Objective

This study aims to assess the educational needs and professional competencies of community pharmacists in Qatar to inform the development of relevant continuing professional development (CPD) programs.

Methods

A mixed-methods cross-sectional exploratory study targeting community pharmacists was conducted using a questionnaire and an event diary. Descriptive and inferential analyses were utilized to analyze the data using the Statistical Package for Social Sciences (SPSS®) version 21 software. For the event diary, thematic content analysis was used for data analysis.

Results

Drug information skills and pharmaceutical care process were the most identified topics for inclusion in CPD programs. None of the pharmacists thought that they were competent in core areas of pharmacy practice. Community pharmacists who filled an event diary highlighted the need for development in areas such as communication skills and medication safety.

Conclusion

The identified needs shall help in developing a CPD program that addresses what community pharmacists perceive as educational and professional training needs.

Use of secret simulated patient followed by workshop based education to assess and improve inhaler counseling in community pharmacy in Jordan

Objectives:

To assess inhaler technique demonstration skills of community pharmacists located in Amman, Jordan via incorporating the trained secret simulated patient (SSP) approach. Secondly, to evaluate the effectiveness of a 2-hour educational workshop focused on SSP feedback.

Methods:

This cross-sectional study involved community pharmacies located in Amman, Jordan. Initially, a trained SSP was involved to enact baseline visits requesting advice on how to use Ventolin® (a pressurized metered-dose inhaler; pMDI) and Pulmicort® (a Turbohaler inhaler, TH). Immediately after each visit, the SSP completed an inhaler technique evaluation form with inhaler checklists based on previously published checklists (consisting of 9 and 10 items for pMDI and TH respectively). The SSP invited all participating pharmacists to a 2-hour workshop that included feedback on their demonstration skills, and the second evaluation of their inhaler technique. The workshop included a summary of the initial visits’ results highlighting pharmacists’ performance.

Results:

Sixty pharmacies were visited and 120 inhaler assessments were completed. During baseline assessment, pharmacists scored an average of 4.5 out of 9 for pMDI and 4.9 out of 10 for TH. Only 11 pharmacists (18.3%) attended the workshop. During the workshop, inhaler technique demonstration skills significantly improved, as scores improved from 5.4 (SD 1.6) to 7.8 (SD 0.9) (p=0.008) and from 4.6 (SD 2.5) to 9.9 (SD 0.6) (p=0.003) for pMDI and TH respectively.

Conclusions:

The SSP approach revealed a lack of ability to demonstrate correct inhaler technique for pMDI and TH inhalers by community pharmacists in Amman, Jordan. A focused educational workshop based on SSP feedback improved inhaler technique significantly.

Do north-eastern German pharmacies recommend a necessary medical consultation for acute diarrhoea? Magnitude and determinants using a simulated patient approach

Background: To determine if pharmacy staff in Germany referred patients to a medical consultation for a scenario in which consulting a doctor was mandatory ('appropriate outcome') and what the quality of questioning and - if a medication was dispensed - the quality of information provided were in this context. Moreover, to determine which factors predicted a necessary referral to a doctor. Methods: A cross-sectional covert simulated patient study was conducted in a random sample of community pharmacies stratified by location in the German state of Mecklenburg-Vorpommern. Each pharmacy was visited once by one of four trained investigators. They simulated a symptom-based request involving a grandmother with acute diarrhoea. A multivariate binary logistic regression analysis using potential variables from bivariate analysis was carried out to determine the predictors for a referral to a doctor. Results: All 199 planned visits were conducted. A necessary referral to a doctor was recommended in 59.8% (n=119) of all test purchases. Multivariate analysis revealed that a non-pharmacist as opposed to a pharmacist and two or more questions as opposed to no questions were significantly associated with a referral to a doctor. Conclusions: Regarding the necessary referral to a doctor, an enormous potential for improvement was revealed for community pharmacies in the German state of Mecklenburg-Vorpommern. The results should make both the Mecklenburg-Vorpommern pharmacy association and legislators aware of the need to significantly escalate their quality management efforts.

Do north-eastern German pharmacies recommend a necessary medical consultation for acute diarrhoea? Magnitude and determinants using a simulated patient approach

Background: In Germany, non-pharmacists (pharmacy technicians and pharmaceutical technical assistants) are permitted to advise on and sell medications in addition to pharmacists. The aim of this study was to determine if pharmacists and non-pharmacists referred patients to a medical consultation for a scenario in which consulting a doctor was mandatory ('appropriate outcome') and what the quality of questioning and - if a medication was dispensed - the quality of information provided were in this context. The study also aimed to determine which factors predicted a necessary referral to a doctor. Methods: A cross-sectional, covert simulated patient study was conducted in a random sample of community pharmacies stratified by location in the German state of Mecklenburg-Vorpommern. Each pharmacy was visited once by one of four trained investigators. They simulated a symptom-based request involving a grandmother with acute diarrhoea. A multivariate binary logistic regression analysis using potential variables from bivariate analysis was carried out to determine the predictors for a referral to a doctor. Results: All 199 planned visits were conducted. A necessary referral to a doctor was recommended in 59.8% (n=119) of all visits. The most commonly asked question was 'for whom is the medication?' (75.4%, n=150), while 'clarification by a doctor' was asked the least (17.6%, n=35). In 87.9% (n=175) of all visits a medication was dispensed. Multivariate analysis revealed that, unlike pharmacists, non-pharmacists have a 2.446 times higher likelihood of recommending a referral to a doctor (p = 0.044; 95% CI = 1.025-5.835). Conclusions: In almost half of the visits a necessary referral to a doctor was not recommended. Furthermore, the quality of questioning and the quality of information were below expectations. Moreover, involvement of non‑pharmacists was surprisingly identified as a relevant factor influencing the appropriate outcome.

Medication dispensing, additional therapeutic recommendations, and pricing practices for acute diarrhoea by community pharmacies in Germany: a simulated patient study

BACKGROUND

In Germany over-the-counter medications (OTC) - which since 2004 are no longer subject to binding prices - can only be purchased in pharmacies. Pharmacy owners and their staff therefore have a special responsibility when dispensing, advising on and setting the prices of medications.

OBJECTIVE

The aim of this study was to assess medication dispensing, additional therapeutic recommendations and pricing practices for acute diarrhoea in adults and to evaluate the role of the patient's approach (symptom-based versus medication-based request) in determining the outcome of these aspects.

METHODS

A cross-sectional study was conducted from 1 May to 31 July 2017 in all 21 community pharmacies in a medium-sized German city. Symptom-based and medication-based scenarios related to self-medication of acute diarrhoea were developed and used by five simulated patients (SPs) in all of the pharmacies (a total of 84 visits). Differentiating between the different test scenarios in terms of the commercial and active ingredient names and also the prices of the medications dispensed, the SPs recorded on collection forms whether the scenario involved generic products or original preparations as well as whether recommendations were made during the test purchases regarding an additional intake of fluids.

RESULTS

In each of the 84 test purchases one preparation was dispensed. However, a preparation for oral rehydration was not sold in a single test purchase. On the other hand, in 74/84 (88%) of test purchases, medications with the active ingredient loperamide were dispensed. In only 35/84 (42%) of test purchases, the patient was also recommended to ensure an 'adequate intake of fluids' in addition to being dispensed a medication. In symptom-based scenarios significantly more expensive medications were dispensed compared to the medication-based scenarios (Wilcoxon signed rank test: z = -4.784, p < 0.001, r = 0.738). Also within the different scenarios there were enormous price differences identified - for example, in the medication-based scenarios, even for comparable loperamide generics the cheapest preparation cost EUR 1.99 and the most expensive preparation cost EUR 4.53.

CONCLUSIONS

Oral rehydration was not dispensed and only occasionally was an adequate intake of fluids recommended. There were also enormous price differences both between and within the scenarios investigated.

Evaluation of Counseling Practices and Patient's Satisfaction Offered by Pharmacists for Diabetics Attending Outpatient Pharmacies in Al Ahsa

Introduction

Patient counseling can be helpful in improving the outcome of disease management, particularly chronic diseases such as diabetes mellitus, which is common in Saudi Arabia. The present study looks to investigate the levels of counseling and satisfaction among patients attending diabetic clinics in outpatient hospital pharmacy in Al Ahsa, Saudi Arabia.

Method

This is a cross-sectional investigation, carried out by using interview-structured questionnaire, targeting diabetes mellitus patients with or without comorbid states. The questionnaire was divided into 3 parts comprising of demographics, counseling types given while collecting prescription, and satisfaction rating of services provided.

Result

More males than females participated; most of whom were college graduates older than 51 years. Sixty-three percent of the entire participants are type 1 diabetic patients, while 37% are type 2 diabetes mellitus patients. Coexistence of hypercholesterolemia was higher among type 1 diabetes patients with 51.9%, while hypertension was more common among type 2 diabetic patients representing 68.2%. Findings also showed that counseling was provided for medication use among type 1 diabetic patients but was deficient in the case of type 2 diabetic patients. Patients received low level of counseling on side effects and healthy lifestyle living. Satisfaction level was only 11.1%, indicating that counseling services might be deficient.

Conclusion

This study has revealed poor counseling practices and low satisfaction levels in services provided by outpatient hospital pharmacies to diabetic patients. In the face of increasing prevalence of diabetes and comorbidity, counseling of diabetic patients is critical.

Assessment of patient counselling on the common cold treatment at Slovak community pharmacies using mystery shopping

BACKGROUND

Up to now, there have been no data on patient counselling in the Slovak community pharmacies. The literature provides a wide range of activities for which mystery shopping methodology be used, including assessment of patient counselling.

AIMS AND OBJECTIVES

To assess patient counselling on the common cold treatment with OTC medicine containing zinc provided by Slovak community pharmacists. To analyse this counselling considering the set scenarios, counsellors and their age.

METHODS

54 pharmacy students visited 270 different community pharmacies throughout Slovakia in 2 weeks in October 2016 to conduct mystery shopping with set scenarios. For assessment of patient counselling, we defined Counselling Performance. It was conceptualised as weighted mean percentage counselling successes rate of its three categories (Identification, Information and Communication) and their weights. Individual perception of counselling evaluated separately. Student t-test and Person's chi-squared test (p < 0.05) and Cohen delta were used for comparing outcomes and effect size of counselling. A simple linear regression was used to find relationships.

RESULTS

The total Counselling Performance was 39.0 ± 22.4%, Identification 30.6 ± 28.7%, Information 39.8 ± 25.1% and Communication 74.3 ± 11.5%. 26.3% pharmacies achieved the average Counselling Performance (41-60%). Subjective Perception had a success rate of 73.4 ± 21.2%, but it could be predicted by the Counselling Performance and the success rate of the three categories only in 1/5 pharmacies. Spontaneous counselling was provided more by pharmacy technicians (p = 0.0009). The duration of counselling was similar when comparing both scenarios, counsellors and their age. The product-requested scenario achieved a higher success rate in the Information category (p = 0.0304; d = 0.27). Pharmacists achieved a higher Counselling Performance (p < 0.0001; d = 0.48) and success rate in categories Identification (p = 0.0001, d = 0.46), Information (p = 0.0004, d = 0.37), and Perception (p = 0.0007; d = 0.54). The estimated age of counsellors did not have any impact on the counselling.

CONCLUSION

Patient counselling on the common cold showed a suboptimal level, particularly considering its content. In the study, we found a significant relationship between the success of counselling and counsellors.

An assessment of counseling quality provided by community pharmacies to type 2 diabetic adult patients for oral therapy: a simulated patient study from Pakistan

This study was conducted to assess quality of counseling provided to type 2 diabetic patients. For this cross-sectional study, a simulated patient method was applied in 562 selected community pharmacies of Punjab, Pakistan. A scenario for the metformin oral therapy was developed that illustrates direct counseling for adult diabetic patients. Counseling and communication skills were also assessed. Descriptive statistics and chi-square tests were used for analysis. Only 29.4% of simulated patients received medication counseling directly; 47.6% received it on request. About 32.8% of clients were referred to a physician without counseling. The most frequently provided information was dietary instruction (94.8%) and dose of therapy (84.5%). Only one quarter (25.3%) of simulated patients were asked about disease duration and similar rate (25.0%) was found for discussions of special warnings. The side effects, drug storage, drug-drug interactions and duration of therapy were ignored. Minimal information was provided about other medication during therapy (0.2%) and effect of medicine withdrawal (2.7%). About 59.5% simulated patients were instructed for compliance to medication. Counseling to type 2 diabetic patients in Pakistani community pharmacies is not very satisfactory. Pharmacies' staff have little focus on counseling. Professional training of staff could improve counseling and communication skills.

A Call to Action to Transform Pharmacy Education and Practice in the Arab World

Globally, pharmacy education is evolving to reflect a more patient-centered, interprofessional approach to clinical practice. In the 22 countries of the Arab world, advancements in regulatory support for pharmacy practice and changes to the health care system have been slower than in Europe, Asia, and the Americas. Significant cultural, logistical, and legal barriers exist in many countries, and a consensus approach to accreditation, educational outcomes, and curricula design is lacking. This commentary briefly examines the current state of both pharmacy education and practice in the Arab world, and it highlights recent reports of curricular reform and innovation. Additionally, it provides potential strategies for improving the quality of education and for expanding pharmacy practice to ensure graduates and practitioners have adequate experiential opportunities and institutional support.

A simulated patient evaluation of pharmacist's performance in a men's mental health program

Objective

The Headstrong program, a pharmacy based men’s mental health promotion program, was designed to enhance pharmacists’ care of men with mental illness and addictions and was focused on six conditions. A simulated patient (SP) encounter on insomnia was used to evaluate pharmacist’s performance as a part of the Headstrong program.

Results

Six Headstrong pharmacists consented to participate in the SP encounter as part of the evaluation of the Headstrong program. Pharmacists’ mean scores in most categories that were evaluated (e.g., pre-supply/assessment score, sleep score) were lower than expected. In assessing the SP during the encounter, pharmacists’ mean score was 5.7 (SD 2.0) of a possible 13 points. No pharmacists asked about the SP’s age, availability of other supports, allergies, and whether they had an existing relationship with a pharmacist. One pharmacist inquired about medical conditions, and two asked about pre-existing mental health conditions. Three pharmacists inquired about concurrent medications. The Headstrong program was discussed by half of the pharmacists and a resource recommended by the Headstrong program was suggested by one pharmacist. Several pharmacists used self-disclosure as a mechanism to support rapport building. Overall, the SP felt cared for and respected by the pharmacists and had confidence in their knowledge.