Assessment of disease management of insomnia at community pharmacies through simulated visits in Pakistan

Abstract

*Objective: The study aimed to document the state of insomnia management at community pharmacies in Pakistan. Methods: A cross-sectional study was conducted at randomly selected 371 pharmacies in three cities of Pakistan. Simulated patient visits were performed to collect information on case management of insomnia in terms of history taking and patient counseling at community pharmacies. The data was coded, entered and analyzed by using SPSS Version 16. Kruskal-Wallis and Mann Whitney tests (p<0.05) were performed to find out differences. Results: The patients were mainly handled by salesman 83.8% (n=311), by pharmacist 3.5% (n=13) and pharmacy assistants 12.7% (n=47). The mean dispensing time was 1.11 minutes (SD=5.61) with the range of 0.5 -6 minutes. Of the 371 simulated patients who visited the pharmacies, 72.8% (n=270) subjects were given medicines and 24.3% (n=90) subjects were referred to the doctor for treatment of insomnia. 61.8% (n=193) of the subjects were given benzodiazepines, 35.6% (n=111) antihistamines and 2.6% (n=8) NSAIDs at community pharmacies in the three cities. The mean cost of treatment in case of insomnia was PKR12.7 (SD=10.13, median=10). Conclusions:The disease management of insomnia by community pharmacies in Pakistan is not appropriate. The overall process of history taking, medication counselling and referral practices at community pharmacies either located in rural or urban setting and irrespective of the provider type and location of pharmacies, in the three cities is limited.

A review of the provision of appropriate advice by pharmacy staff for self-medication in developing countries

“…Eleven studies were conducted in Asian regions: India, 44 Indonesia, 37 Pakistan, 26,27 Thailand, 19,39,40 Turkey, 18 and Vietnam. 22,24,32 Six studies came from African regions: Gambia, 33 Kenya, 29 South Africa, 41,45 Sudan, 36 and Zimbabwe, 35 Lastly, 11 studies were undertaken in Latin American and Caribbean regions: Bolivia, 25 Brazil, 34,38 Colombia, 43 Mexico, 20,21,31,42 Jamaica, 23 Latin American, 30 and both Guatemala and Mexico.…”

“…Regarding sampling representativeness; 8 studies used non-random sampling, including: convenience sampling (5 studies), 26,27,29,34,36 purposive sampling (2 studies), 23,37 and quota sampling (1 study). 44 One study, however, did not report the type of sampling used.…”

“…However, in 53 of these 64 scenarios (83%), appropriate advice was provided to a minority of patients (range 0%-47%). [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][35][36][37][38][39][40][42][43][44][45] The definition of appropriate advice varied across studies (Table 1). In 19 of the 28 included studies, authors used their own definition to decide whether the advice provided was considered appropriate.…”

“…In 19 of the 28 included studies, authors used their own definition to decide whether the advice provided was considered appropriate. [18][19][20][21]23,[25][26][27][28]30,31,[35][36][37][39][40][41][42][43] In 8 studies, authors used a national or international Table 1 The criteria to appraise the included studies (1) Did the study address a focused issue? (2) Was the research method appropriate to answer the aim?…”

“…43 Several methods were used to conduct these 28 studies. The patient simulation method was employed in 20 studies, 19,[21][22][23][24][25][26][27][28][29]31,[34][35][36][37][38][39]41,43,44 pharmacy staff interview was performed in 4 studies, 20,30,42,45 and a combination of patient simulation with pharmacy staff interview was employed in 4 studies. 18,32,33,40 The provision of appropriate advice…”