Pharmacists' clinical competency towards oral mucosal diseases: Results from a mystery shopper study

Abstract

ObjectivesTo investigate the clinical advices pharmacists would give to patients who present with various oral mucosal lesions.Subjects and MethodsOne hundred and twenty pharmacists in three major cities in the United Arab Emirates (UAE) were approached by senior dental students acting as mystery shoppers. Pharmacists were shown an image of one of four oral mucosal lesions representing candidosis, aphthous ulcer, erosive lichen planus and squamous cell carcinoma (SCC). Pharmacists' referral pattern and choices of medications were recorded and assessed against demographic variables.ResultsEighty‐eight per cent (88%) of pharmacists dispensed a non‐prescription medication to treat the oral lesions, including SCC, while only 12% recommended that the lesion shown to them be assessed by a clinician. Among all referral recommendations, 32% were for SCC (p = .006). Geographical proximity of a clinic to the pharmacy was a significant factor in determining pharmacists' referral recommendation (p = .036).ConclusionMost pharmacists dispensed a medication for oral mucosal lesions, including potentially malignant and malignant ones, without referring patients to a medical or dental practitioner. Pharmacists should be aware of the serious nature of some oral mucosal lesions and the necessity to refer those cases to a qualified practitioner for proper clinical assessment.

A scoping review of pharmacy participation in dental and oral health care

“…Generally, low referral rates were identified, 45,47,49,51 with pharmacy support staff less likely to refer than pharmacists 39,44‐47,50 . OTC medications or pharmacy products were commonly supplied, with or without a referral, across all the eight studies involving a potentially cancerous lesion, 39,45,47,49,51,58 particularly by pharmacy support staff in three studies 46,47,50 . However, one of these studies found a significantly higher number of doctor, not dental, referrals for a mystery shopper scenario after an educational event, supply of a decision protocol and information packs 58 …”

“…12,26,29,33,37,40,41 Pharmacy professionals generally responded to DOHC inquires by recommending OTC medications, oral health products or oral hygiene advice, with or without dentist or doctor referral. 27,29,33,35,37,[42][43][44] Few studies reported on the types of OTC medication provided or recommended, except for studies that involved mystery shoppers or case vignettes, 39,[44][45][46][47][48][49][50][51] or involved dental pain. 28,30,42,48,52,53 For example, pharmacists and dentists reported a similar pattern of recommending OTC analgesics for dental pain.…”

“…Thirteen articles focussed on how pharmacy staff managed oral conditions, including potential oral cancer, 39,[45][46][47][49][50][51] mouth ulcers, 27,44,48,56 oral thrush, 27 herpes simplex 43 and halitosis 57 (Table 3). Nine studies used mystery shoppers/case vignettes to assess community pharmacy staff responses to oral conditions, 39,[44][45][46][47][48][49][50][51] seven of which focused on oral cancer. Generally, low referral rates were identified, 45,47,49,51 with pharmacy support staff less likely to refer than pharmacists.…”

“…In a United Arab Emirates study, pharmacists were significantly less likely to recommend referral if a medical or dental clinic was within walking distance from the pharmacy. 45 There was evidence that pharmacist referrals and provision of DOHC advice were positively associated with increased years of practice. 42,45 Conflicting associations with age were also reported.…”

Referral patterns in Oral Medicine (Stomatology) and diagnosis delay. A descriptive study

“…Aunque existan restricciones legales en el rol de los farmacéuticos como indicadores y dispensadores de fármacos y/o tratamientos, existe un incremento en esta práctica. Esta situación se agrava, cuando aparte se realizan diagnósticos a partir de la breve historia relatada por el paciente 11 . En un estudio de 2014, se describió la intervención de estos profesionales en diagnósticos odontológicos, sobre todo ligados a odontalgias y úlceras bucales 12 .…”