An investigative assessment on the quality of community pharmacy practice in the United Arab Emirates using common cold scenario

Background: Before dispensing medications to a patient, the pharmacist must obtain appropriate medical and medication history, label medications, and counsel. Due to its investigative and undercover nature, the simulated patient (SP) methodology is often used to assess dispensing practices. Objective: This study aimed at assessing the history-taking, dispensing, and counseling practices of CPs. Methods: This study was conducted among 34 community pharmacists (CPs) from Ajman, United Arab Emirates. Three final undergraduate pharmacy students role-played as simulated patients (SPs) with common cold (ICD-10 code J00) seeking advice from the CPs. The relevant details were documented in a checklist and assessed as per the study objectives. The counseling standards and CP demography were correlated (Pearson correlation coefficient at α=0.05). Results: A total of 34 (male 25; female 9, Arab 5 and non-Arabs 29) CPs were visited by the SPs. The SPs received a total of 105 medications: antihistaminic 23 (21.9%), expectorants 17 (16.19%), antibiotics 14 (13.33), and NSAIDs 13 (12.38%). Of the antibiotics, nine were beta-lactam and five were macrolides. Pseudoephedrine/loratadine (n=8) was the common medication followed by guaifenesin, pseudoephedrine hydrochloride, dextromethorphan hydrobromide, and acetaminophen (n=6), ibuprofen (n=4), amoxicillin/clavulanate potassium (n=4). The information on the duration of medication was provided by only 12 (35.29%) of them and none of them took medication history. The labeling standard was ‘good’ in 20 (58.28%) and ‘poor’ in 4 (11.76%). The average dispensing time was 37.20± 25.97 seconds (Median, IQR; 25.97, 15-52.50). The counseling on allergy was provided by only one pharmacist, side effects by 4 (11.76%), contraindications by 2 (5.88%), and instructions on taking the medication by 31 (91.17%), with an average counseling time of 75.29 ± 74.62 seconds (Median, IQR; 60, 26.25-120). Counseling duration had a positive correlation with cost (p=0.015), and dispensing duration (p=0.000) and was associated with race (Arab versus non-Arab, p=0.003) but not with gender (p=0.800). Conclusions: Poor dispensing practices and improper history-taking existed among CPs resulting in patients receiving medicines that were not needed. Improvements in pharmacy education, consumer education, and inter-professional collaboration may be possible solutions to bridge the practice gaps.