The Practice of the Community Pharmacists in Managing Potential Drug-Drug Interactions: A Simulated Patient Visits

Abstract

Background Drug-drug interactions (DDIs) can cause treatment failure and serious adverse drug reactions, leading to morbidity and mortality. Due to their significant effects on the patient’s health, community pharmacists (CPs) competence in detecting and preventing these interactions is essential to provide optimal health services. Thus, this study aimed to explore the performance of the CPs in situations involving the presence of potential DDIs. Methods A cross-sectional, simulated patient study was conducted in 235 community pharmacies in the Khartoum locality. Two scenarios were used to evaluate the performance of the CPs. Ten final year B. Pharm. students were selected to act as simulated patients (SPs); they were trained for two weeks to familiarize their roles. All encounters were documented immediately after leaving the pharmacy by the SPs in the data collection form. Results All planned SPs visits were completed, resulting in 470 visits. None of the CPs asked about the patients’ medication history in both scenarios. After the SPs provided information about the drug used currently by the patient, 13.6% and 23.4% of the CPs had identified the potential DDIs in scenario 1 and scenario 2, respectively. In scenario 1, 59.4% distinguished the interaction of simvastatin with both drugs, while, in scenario 2, 74.5% recognized the interaction of warfarin with both drugs. In identifying DDIs, around half of the CPs were dependent on their knowledge or using drug interaction checker programs. The most common intervention made by the CPs was referring the patient to the prescriber (56.3% CPs in scenario 1 and 60% CPs in scenario 2). Conclusion CPs practice in identifying and managing potential DDIs was poor. The current CPs practices need substantial improvement. Therefore, professional education and the use of software programs in community pharmacies should be encouraged.

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

“…The target populations in all the studies were CP 28 (62.2%), 19-Boura F, Al-Tabakha M, Hassan N, Darwich M. Critical appraisal of simulated patient methodology to assess the practice of community pharmacist in the Middle East and North Africa region: A systematic review. Pharmacy Practice 2022 Jul-Sep;20(3):2701. https://doi.org/10.18549/PharmPract.2022.3.2701 3 22,24,26,29,30,[32][33][34][35]38,39,41,42,46,47,[49][50][51][52][53][54][55][58][59][60] pharmacy staff (pharmacists and non-pharmacists) 10 (22.2%), 18,23,31,36,37,43,44,48,57,60 and CP and GP 1 (2.2%). 27 Table 1 provides a summary of the descriptive characteristics of the included studies in the review.…”

“…22,36,52 The most outcome measured in the included studies was the adequacy of skill (pre-dispensing and/or post-dispensing) 38 (84.4%), 19,21,22,[24][25][26][27][28][29][30][31][32][33][34][35][36]38,[40][41][42][43][44][45][47][48][49][50][51][52][53][54][55][56][58][59][60][61][62] the the drug use pattern 19 (42.2%). 18,24,26,27,29,[31][32][33]36,[41]…”

“…A broad variety of terms were used in the studies to the individuals used to perform the simulated visits. The individuals were described as SP 37 (82.2%), 19,20,[22][23][24][25][26][27][28][30][31][32][33][34][35][36]38,[41][42][43][44][45][47][48][49][50][51][52][54][55][56][58][59][60][61][62][63] simulated client 10 (22.2%), 18,21,24,27,29,35,39,40,47,5 7 and mystery shopper 10 (22.2%), 23,26,29,32,[40][41][42]54,55,59 mystery patient 3 (6.7%), 21,26,…”

“…21 In addition, many articles provided brief background or defined what was meant by SP or the equivalent term 17 (37.8%). 19,[21][22][23][24][25][26][28][29][30][32][33][34][35][36]38,41,42,45,46,50,[52][53][54][55][56][57][58][59][60]62 The SP were recruited from a different range of backgrounds, including students 25 (55.6%), 18,20,22,24,[26][27][28][29]33,34,36,39,41,42,46,48,49,[52][53]…”

“…Most of the studies recruited only one SP entering each pharmacy 35 (77.8%). 18,19,[21][22][23][24][25][26][27][28][29][30][31][32]34,35,37,38,[40][41][42]46,[48][49][50][51][52][54][55][56][57][59][60][61][62] The majority of the pharmacists were evaluated one time 36 (80%). [18][19][20][21][22][23][24][25]28,[30][31][32][33][34][35][37][38]…”