喀土穆地区社区药剂师对急性腹泻治疗的实践及患者咨询评估：一项模拟患者研究
Assessment of Community Pharmacist's Practice and Patient Counselling Toward Acute Diarrhea Treatment in Khartoum Locality: A Simulated Patient Study.
作者信息
Hamadouk Riham M, Arbab Ahmed H, Yousef Bashir A
机构信息
Department of Clinical Pharmacy, Faculty of Pharmacy, University of Khartoum, Khartoum, Sudan.
Department of Pharmacognosy, Faculty of Pharmacy, University of Khartoum, Khartoum, Sudan.
出版信息
Integr Pharm Res Pract. 2021 Nov 16;10:145-152. doi: 10.2147/IPRP.S340528. eCollection 2021.
BACKGROUND
Acute diarrhea is one of the most common health problems globally as a minor ailment, it is widely managed by community pharmacists (CPs). Professional patient counseling provided in community pharmacies is essential to decide about acute diarrhea and avoid treatment failure properly.
OBJECTIVE
To assess CPs' history-taking practice, medication dispensing, and patient counseling in response to acute diarrhea in adults.
METHODS
A cross-sectional, covert simulated patient (SP) study was conducted in 235 community pharmacies in the Khartoum locality. Two scenarios were used, one scenario assesses afterwards compliance to treatment guidelines and patient counseling, and second scenario determines afterwards if pharmacists referred patients to medical consultation. Six final-year pharmacy students were involved as SPs. All encounters were audio-recorded by SP. Then the investigator filled the checklist that was intended to evaluate the overall practice of pharmacists.
RESULTS
As planned, 235 pharmacies were visited twice, resulting in a total of 470 visits (visit completion rate: 100%). In history taking, the most asked questions were the patient's age (89.8% for scenario 1 and 88.5% for scenario 2). Followed by the presence of blood in the stool (25.5% for scenario 1 and 28.1% for scenario 2). In scenario 1, loperamide was the most dispensed medication (81.3%), while oral rehydration solution (ORS) was dispensed in 0.9% of the visits. In counseling, verbal and written instructions were provided in 47.7% of the visits. Duration of medications was mentioned in 3.8%, advice about fluid intake was offered in 7.2% of the visits. In scenario 2, 17% of the pharmacists managed patient history well to refer patients to medical consultation, while 42.6% recommended referral after sufficient information was provided by the SP.
CONCLUSION
CPs' practice in counseling toward acute diarrhea was poor; referral to medical consultation was below expectation. The current CPs dispensing practices need improvement; thus, professional education should be encouraged.
背景
急性腹泻是全球最常见的健康问题之一，作为一种小病，社区药剂师（CPs）对其进行广泛管理。社区药房提供的专业患者咨询对于正确判断急性腹泻并避免治疗失败至关重要。
目的
评估社区药剂师针对成人急性腹泻的问诊实践、药物调配及患者咨询情况。
方法
在喀土穆地区的235家社区药房开展了一项横断面、隐蔽模拟患者（SP）研究。使用了两种场景，一种场景评估之后对治疗指南的遵循情况及患者咨询情况，另一种场景确定之后药剂师是否将患者转诊至医疗咨询处。六名药学专业最后一年的学生作为模拟患者参与。所有问诊均由模拟患者进行录音。然后研究者填写旨在评估药剂师整体实践情况的检查表。
结果
按计划，对235家药房进行了两次走访，共走访470次（走访完成率：100%）。在问诊中，最常问到的问题是患者年龄（场景1为89.8%，场景2为88.5%）。其次是粪便中是否带血（场景1为25.5%，场景2为28.1%）。在场景1中，洛哌丁胺是最常调配的药物（81.3%），而口服补液盐（ORS）在0.9%的走访中被调配。在咨询方面，47.7%的走访提供了口头和书面指导。3.8%的走访提到了用药时长，7.2%的走访给出了液体摄入方面的建议。在场景2中，17%的药剂师对患者病史处理得当，将患者转诊至医疗咨询处，而42.6%的药剂师在模拟患者提供足够信息后建议转诊。
结论
社区药剂师对急性腹泻的咨询实践较差；转诊至医疗咨询处的情况未达预期。当前社区药剂师的调配实践需要改进；因此，应鼓励开展专业教育。
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