A systematic review of the use of simulated patients and pharmacy practice research

Abstract

ObjectiveThe use of simulated patients to assess current practice, or to derive outcome measures for pharmacy practice research, has received much attention in recent years. A simulated patient is an individual who is trained to visit a pharmacy to enact a scenario testing specific behaviour of the pharmacist or pharmacy staff. The aim of this study was to provide a definitive review of the use of simulated patients as a methodological tool for pharmacy practice research. MethodA systematic review was undertaken to identify all pharmacy practice studies that had used simulated patient methodology. The electronic databases searched to identify relevant studies were MEDLINE, EMBASE and CINAHL. Articles fulfilling all the following criteria were considered for inclusion in the review: primary reports of trials conducted in community pharmacy and drug store settings which used simulated patients to derive outcome measures. The review was not restricted by language or by country. The review was restricted to publications from 1976 to May 2005. Key findingsIn total, 56 full publications were retrieved for further examination, of which 46 studies were included in the review, including: nine randomised controlled trials, three controlled trials, 30 cross-sectional, two time-series and two 'other' studies. Ten publications were excluded: seven reviews, one laboratory-based study, one telephone survey and one study presented only as an abstract. ConclusionsThere has been steady growth in the use of simulated patient methodology over the past 30 years. Although simulated patients have received negative attention in the pharmaceutical media, they can be a rigorous and robust method of measuring practice if used appropriately. This review demonstrates the range of activities for which this method can be used, including the assessment of counselling and advice provision, the treatment of minor and major illness, and the assessment of the public health activities of pharmacy and drug store staff. Simulated patient methodology has been used in developing countries to a similar, if not greater extent, than the developed world, demonstrating its versatility and applicability to pharmacy practice research globally.

Effectiveness of implementation strategies for clinical guidelines to community pharmacy: A systematic review

“…These included, inadequately addressing incomplete data, lack of similarity in baseline measurements and protection from contamination in the study. It was not clear if these Key: Simulated patient methodology: this involves data collection using covert patients (mystery shoppers) to assess pharmacy practice [95] …”

Treatment of pediatric diarrhea: a simulated client study at private pharmacies of Ujjain, Madhya Pradesh, India

“…Simulated client (SC) is a versatile tool that has been widely used in both low-and high-income settings to assess the actual practices of pharmacies and drugstores [12]. Childhood diarrhea is one of several illnesses that have been assessed in pharmacies by using SC [9,13,14].…”

A system for monitoring quality standards in the provision of non-prescription medicines from Australian community pharmacies

“…While other studies employing pseudo-patient methodology have been described in the literature [18,[20][21][22][23][24][25][26], the rigour of the system employed by the QCPSC is strengthened by the inclusion of a number of factors in the research design. These aspects, which are discussed in further detail in another paper [19], go beyond what is recommended in a systematic review of studies involving pseudo-patient methodology [18], and include:…”

“…The visits employ pseudopatient or ''mystery-shopper'' methodology, a technique which involves a person entering a particular heath setting for the purpose of observing and/or testing the health care process, rather than seeking treatment [17]. The technique, commonly used in the retail setting, was introduced to community pharmacy in Australia by de Almeida Neto et al [17], and has also been used in other countries in a variety of forms, using terminology such as ''pseudo-customer'' and ''simulated patients'' [18].…”

“…Audio-taping has been highlighted as important for the validity of pseudo-patient methodologies [18][19][20]. The tape is not used for any purpose other than to verify the accuracy of the pseudopatient's report of the interaction and the tape is erased three months after the event.…”