Assessing insomnia management in community pharmacy setting in Jordan: A simulated patient approach

Abstract

Insomnia is one of the most common minor ailments to which patients seek advice in a community pharmacy setting. Due to the availability of a wide variety of over-the-counter (OTC) products, community pharmacists are in the front line to safe-guard patients looking for self-medication or advice for treatment of insomnia. The purpose of this study was to assess the content of community pharmacists’ interactions with patients seeking advice for insomnia in Jordan. A cross-sectional study using a simulated patient methodology was conducted across a stratified convenience sample of community pharmacies in three major cities in Jordan. The visits were evaluated using pre-defined criteria adapted from published literature relating to content and counseling skills. Visits were audio-recorded using a hidden microphone and the simulated patient completed a data collection form immediately after each visit. A total of 67 community pharmacies (response rate = 93.0%) agreed to participate and were all visited once by the simulated patient. The median duration of the visit was 2 minutes (range: 0.2–4 minutes). The majority (86.6%) of visits resulted in the sale of a drug, most commonly a combination product (paracetamol and diphenhydramine) for 30 recommendations (44.8%). This was followed by a natural plant extract combination product, namely valerian and lemon balm (Melissa officinalis L.) for 23 (34.3%). Pharmacists often did not question medical history or other symptoms prior to product sale. Frequently, the recommended dose (49.3%) and administration time (38.8%) were the only information provided to the patient. No information was provided in relation to potential drug interactions or contraindications. No advice was offered on lifestyle or good sleeping hygiene. This study provided evidence that community pharmacists in Jordan in general did not offer adequate counseling for patients seeking advice for insomnia. Exploration of the reasons and factors contributing to this practice and highlighting professional opportunity and responsibility is recommended.

Does drug dispensing improve the health outcomes of patients attending community pharmacies? A systematic review

“…The results of this systematic review demonstrate the positive influence of drug dispensing on the health outcomes of patients attending community pharmacies. Studies that address drug dispensing usually assess the quality of the practice showing a non-systematized and undocumented process [ 26 , 30 , 58 ]. Several strategies have been proposed to qualify this service, such as the development of instruments to support the practice and training pharmacists and pharmacy teams [ 27 , 38 , 59 ].…”

Community pharmacists' management of minor ailments in developing countries: A systematic review of types, recommendations, information gathering and counselling practices

“…The methodological and participant characteristics of all the included studies are as shown in Table 1 A majority (29/30) (96.7%) of the included studies were crosssectional in study design while only one study used a combination of semistructured interview with cross-sectional design. 54 About two-thirds of the studies used nonprobability sampling methods (convenience and purposive), 39,41,42,44,45,46,47,51,52,54,55,56,60,61,63,64,65,66,68 and a priori sample size calculation was done in 36.7% (11/30) of all the studies. The data collection method used in half of the studies (50%) (15/30) was survey with self-administered questionnai res, 41,43,45,47,49,51,53,56,57,58,59,60,61,62,64,68 followed by the use of simulated patients (36.7%) (11/30), 39,41,42,44,46,48,52,54,…”

“…54 About two-thirds of the studies used nonprobability sampling methods (convenience and purposive), 39,41,42,44,45,46,47,51,52,54,55,56,60,61,63,64,65,66,68 and a priori sample size calculation was done in 36.7% (11/30) of all the studies. The data collection method used in half of the studies (50%) (15/30) was survey with self-administered questionnai res, 41,43,45,47,49,51,53,56,57,58,59,60,61,62,64,68 followed by the use of simulated patients (36.7%) (11/30), 39,41,42,44,46,48,52,54,63,65 combination of survey and simulated patients (10%) (3/30) 50,55,…”

“…Community pharmacists encountered 11-30 customers per day with minor ailments with an average of 4.8 (1.3-20.5) minutes per encounter 40,41,42,43,44,46,48,51,65,66,67 The most frequent minor ailments reported were respiratory conditions such as cough and colds; gastrointestinal disturbances such as nausea, vomiting, diarrhoea, constipation and heartburn; headache and fever; musculoskeletal pain and minor injuries; allergy, skin problems. The most common medicines recommended or requested for were cough and cold preparations including antitussives and antihistamines, antiemetics, antidiarrhoea, laxatives, analgesics (including nonsteroidal anti-inflammatory drugs [NSAID]), antipyretic and skin preparations.…”

“…The most common medicines recommended or requested for were cough and cold preparations including antitussives and antihistamines, antiemetics, antidiarrhoea, laxatives, analgesics (including nonsteroidal anti-inflammatory drugs [NSAID]), antipyretic and skin preparations. 39,40,41,42,43,44,45,46,47,48,49,50,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68 However, some recommendations including antibiotics, analgesic and combination of first generation antipsychotic and antidepressant made by community pharmacists were considered inappropriate and reported by 44.4% (12/27) of studies for acute diarrhoea cough /colds, headache and insomnia, respectively. 39,40,46,48,49,50,52,54,55,63,65,66 Three of the studies also reported occasional recommendation of nonpharmacological interventions by community pharmacists for the management of minor ailments (32.3%).…”