Predictors of Recommending Non-Pharmacological Therapy for Cough during Pregnancy by the Community Pharmacists in the United Arab Emirates (UAE): A Simulated-Patient Approach.

Background: Cough is common during pregnancy. Community Pharmacists (CPs) can provide high-quality cough assessment and management services during pregnancy, including nonpharmacological and pharmacotherapies. In pregnant women, non-pharmacological approaches may be preferred as a first line of treatment for cough to minimize the potential side effects associated with pharmacological therapies. Objective: This study aimed to determine if CP characteristics (age, gender, job title, and experience) can predict clinical competencies as related to patient assessment, and act as predictors of recommending a non-pharmacological therapy for cough as first-line therapy for pregnant women. A secondary aim of this study was to further evaluate CP counselling and communication skills by measuring the levels of patient satisfaction following interactions. Methods: A cross-sectional, simulated patient (SP) study was conducted among 200 community pharmacies selected randomly in Dubai, Sharjah, and Ajman emirates (UAE). A cough scenario was developed, and two fourth-year pharmacy students role-played an SP visiting community pharmacies and requesting symptom relief from a cough. A formal assessment tool was used and consisted of 29 questions to assess the comprehensiveness of CPs’ cough assessment, management, counselling, and communication skills. A descriptive and bivariate analysis of the data was undertaken.Results: Two hundred pharmacies were visited, and 88.5% of CPs asked about the description of cough symptoms. Around a third of the CPs (32.5%) did not ask follow-up questions to determine if the SP had any other symptoms, such as sinusitis, a cold, or gastric reflux. 68.0% of the CPs did not successfully ascertain that the SP was pregnant. Most CPs (97%) forgot to ask about patients’ allergies to medicine, and (43.5%) did not ask if the SP had sought any medication for the cough. More than half of the CPs (62%) had not addressed the non-pharmacological treatment. Just over two-fifths (44.5%) of the CPs prescribed the SP with Prospan® cough syrup, and 3.5% of CPs recommended antibiotics for a cough. 82% of CPs did not use any source of information other than their general knowledge and expertise. Most (80%) of the SPs were either very highly satisfied or highly satisfied with cough counselling provided by the CPs. In addition, we found that age(AOR=1.489, 95% CI: 1.095-2.026, P-value= 0.01), gender(AOR=0.344, 95% CI:0.244-0.486, P-value ≤0.001), job title (AOR= 1.914; 95% CI: 1.353-2.708, P-value< 0.001), and educational levels of CPs (AOR= 0.696; 95% CI: 0.513-0.946, P-value=0.020), is predictors of non-pharmacological therapies to SPs by the CPs in the UAE. Conclusion: This study is the first in the UAE to determine the predictors of prescribing non-pharmacological treatment to pregnant women with cough by CPs, which has practical implications for CP training and education programs. Enhancing CPs’ knowledge of non-pharmacological approaches to managing cough will improve maternal health.