Malik Madeeha, Hassali Mohamed A, Shafie Asrul A, Hussain Azhar, Aljadhey Hisham, Saleem Fahad
Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia. Penang, (Malaysia) & Hamdard Institute of Pharmaceutical Sciences, Hamdard University. Islamabad, (Pakistan).
Pharm Pract (Granada). 2013 Jan;11(1):8-16. doi: 10.4321/s1886-36552013000100003. Epub 2013 Mar 28.
To document the case management of uncomplicated malaria fever at community pharmacies located in the two major cities of Pakistan; Islamabad (national capital) and Rawalpindi (twin city).
A comparative, cross-sectional study was designed to document the management of uncomplicated malaria fever at community pharmacies in twin cities of Pakistan through simulated patient visits. Visits were conducted in 238 randomly selected pharmacies to request advice for a simulated patient case of malaria. The pharmacy's management was scored on a checklist including history taking and provision of advice and information. Kruskal-Wallis test and Mann-Whitney U test were used to compare management of uncomplicated malaria fever by different types of dispensers working at community pharmacies situated at different locations in the twin cities.
The simulated patients were handled by salesmen (74.8%, n=178), pharmacist (5.4%, n=13) and diploma holders (19.8 %, n=47). Medication was dispensed in 83.1 % (n=198) of the visits, but only few of the treated cases were in accordance to standard treatment guidelines for malaria. However, in 14.8% (n=35) of the cases the simulated patients were directly referred to a physician. There was a significant difference observed in the process of history taking performed by different dispensers (e.g. pharmacist, pharmacy assistant, pharmacy diploma holders and salesman) while no significant differences in the provision of advice by these dispensers was observed. Pharmacists were seen more frequently involved in the process of history taking if available at the community pharmacies. On the other hand, no significant differences were observed in the case management (history taking and provision of advice) for the treatment of malaria fever among community pharmacies situated at different locations (e.g. near hospital/super market/small market) in the twin cities.
The results of the study revealed that the overall process of disease management of uncomplicated malaria fever at community pharmacies was not in accordance with the national standard treatment guidelines for malaria. Patients were being treated by untrained personnel's at community pharmacies without any understanding of referral. However, pharmacists were more frequently involved in history taking, though their availability was low at community pharmacies.
记录巴基斯坦两个主要城市——伊斯兰堡（首都）和拉瓦尔品第（双子城）的社区药房对单纯性疟疾热的病例管理情况。
设计了一项比较性横断面研究，通过模拟患者就诊来记录巴基斯坦双子城社区药房对单纯性疟疾热的管理情况。在238家随机选择的药房进行就诊，就一个模拟的疟疾病例寻求建议。根据包括病史采集以及建议和信息提供情况的清单对药房的管理进行评分。使用Kruskal-Wallis检验和Mann-Whitney U检验来比较在双子城不同地点的社区药房工作的不同类型药剂师对单纯性疟疾热的管理情况。
模拟患者由销售人员处理的占74.8%（n = 178），药剂师处理的占5.4%（n = 13），文凭持有者处理的占19.8%（n = 47）。83.1%（n = 198）的就诊中配了药，但只有少数治疗病例符合疟疾的标准治疗指南。然而，14.8%（n = 35）的病例中模拟患者被直接转诊给医生。不同药剂师（如药剂师、药房助理、药房文凭持有者和销售人员）进行病史采集的过程存在显著差异，而这些药剂师在提供建议方面未观察到显著差异。如果社区药房有药剂师，会更频繁地看到他们参与病史采集过程。另一方面，在双子城不同地点（如医院/超市/小市场附近）的社区药房中，对疟疾热治疗的病例管理（病史采集和建议提供）未观察到显著差异。
研究结果表明，社区药房对单纯性疟疾热的疾病管理总体过程不符合国家疟疾标准治疗指南。社区药房里未经培训的人员在不了解转诊的情况下对患者进行治疗。然而，药剂师更频繁地参与病史采集，尽管他们在社区药房的可获得性较低。
