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

Simulated patient methodology as a "gold standard" in community pharmacy practice: Response to criticism

The simulated patient methodology (SPM) is considered the "gold standard" as covert participatory observation. SPM is attracting increasing interest for the investigation of community pharmacy practice; however, there is criticism that SPM can only show a small picture of everyday pharmacy practice and therefore has limited external validity. On the one hand, a certain design and application of the SPM goes hand in hand with an increase in external validity. Even if, on the other hand, this occurs at the expense of internal validity due to the trade-off situation, the justified criticism of the SPM for investigating community pharmacy practice can be countered.

Managing infectious diarrhea among young children in community pharmacies in Saudi Arabia and the implications for AMR

Introduction

Diarrhea remains a major global health issue for children under five, contributing substantially to morbidity and mortality. Community pharmacists play a pivotal role in the management of these children; however, their competence in managing childhood diarrhea in Saudi Arabia is under-researched. This is important to ensure optimal patient care.

Method

Simulated patients (SPs) presenting with three pediatric diarrhea scenarios were used to evaluate pharmacists' practice in terms of their counselling, history taking, over-the-counter (OTC) prescribing, medication instructions, diet/fluid advice, and/or information provision. Pharmacists' practice was categorized into adequate, less adequate, and poor.

Results

182 community pharmacists, primarily male and non-Saudi, participated in the study, of which 60% were in chain pharmacies. Only 5% showed adequate practice in currently managing pediatric diarrhea. Of the 182 simulated patient visits, 62% received medication in all three scenarios and 20% were referred to physicians, with 16% of pharmacists failing to provide any form of intervention. The main medications recommended were kaolin (34%), pectin (34%) and metronidazole (11%). While most pharmacists (86%) asked about the patient's identity and age, 15% provided incorrect management information, 16% failed to provide guidance on the prescribed medicines, and 18% dispensed antimicrobials without a valid prescription.

Conclusion

A high level of inadequate management of pediatric diarrhea in Saudi Arabia was observed. This highlights the need for extensive training to improve community pharmacists' practice in service delivery including providing counselling and advice on the appropriate management of childhood diarrhea. The latter is particularly important to reduce antimicrobial resistance.

Community pharmacists' response to complaints of gastroesophageal reflux: A simulated patient study in the Northern United Arab Emirates

INTRODUCTION

Patients frequently use gastric acid-reducing agents (ARAs) to treat symptoms affecting the gastrointestinal tract. Thus, the risk for drug-drug interactions (DDI) is a serious concern. This potentially makes the community pharmacist (CP) act as a primary intervention by providing the appropriate counseling and dispensing practice.

OBJECTIVE

To evaluate CPs' counseling and dispensing practices regarding complaints of Gastroesophageal Reflux Disease (GERD), including recommending an appropriate course of action to prevent possible DDIs.

MATERIALS AND METHODS

A simulated patient (SP) methodology was used in this study. The community pharmacies in Ajman and Sharjah were visited by SP who's responsible for acting as a patient, and by an observer who's responsible for focusing on the interaction between the SP and the CPs without engagement. Data were recorded using a preprepared data collection form. Performance feedback was sent to the CPs after concluding all visits. Counseling and dispensing scores were classified based on the total scores to poor, inadequate, and complete. Appropriateness of the pharmacist's decision was defined as dispensing antacid and advising of separating doses apart in time.

RESULTS

A total of 150 community pharmacies was included in the data analysis. The findings of the current study demonstrated poor counseling and dispensing for the vast majority of the participants (81.3% and 67.3% of respondents, respectively). Only 4% of the CPs advised the SP to have a time interval between antacid and cefuroxime axetil. A significant difference in counseling scores was found between pharmacies located in Ajman and Sharjah (p = 0.01). Also, there was a significant difference in dispensing scores between independent and chain pharmacies (p = 0.003).

CONCLUSIONS

The findings revealed inadequate counseling and dispensing practice by CPs. This study highlighted the need for continuous professional training programs to endow the CPs with the knowledge necessary for improving the CPs' counseling and dispensing practices.