Assessing insomnia management in community pharmacy setting in Jordan: A simulated patient approach

Autoři: Mayyada Wazaify aff001;  Eman Elayeh aff001;  Razan Tubeileh aff001;  Eman A. Hammad aff001
Působiště autorů: Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, University of Jordan, Amman, Jordan aff001
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article


Insomnia is one of the most common minor ailments to which patients seek advice in a community pharmacy setting. Due to the availability of a wide variety of over-the-counter (OTC) products, community pharmacists are in the front line to safe-guard patients looking for self-medication or advice for treatment of insomnia. The purpose of this study was to assess the content of community pharmacists’ interactions with patients seeking advice for insomnia in Jordan. A cross-sectional study using a simulated patient methodology was conducted across a stratified convenience sample of community pharmacies in three major cities in Jordan. The visits were evaluated using pre-defined criteria adapted from published literature relating to content and counseling skills. Visits were audio-recorded using a hidden microphone and the simulated patient completed a data collection form immediately after each visit. A total of 67 community pharmacies (response rate = 93.0%) agreed to participate and were all visited once by the simulated patient. The median duration of the visit was 2 minutes (range: 0.2–4 minutes). The majority (86.6%) of visits resulted in the sale of a drug, most commonly a combination product (paracetamol and diphenhydramine) for 30 recommendations (44.8%). This was followed by a natural plant extract combination product, namely valerian and lemon balm (Melissa officinalis L.) for 23 (34.3%). Pharmacists often did not question medical history or other symptoms prior to product sale. Frequently, the recommended dose (49.3%) and administration time (38.8%) were the only information provided to the patient. No information was provided in relation to potential drug interactions or contraindications. No advice was offered on lifestyle or good sleeping hygiene. This study provided evidence that community pharmacists in Jordan in general did not offer adequate counseling for patients seeking advice for insomnia. Exploration of the reasons and factors contributing to this practice and highlighting professional opportunity and responsibility is recommended.

Klíčová slova:

Critical care and emergency medicine – Drug therapy – Drugs – Insomnia – Patients – Pharmacists – Sleep


1. Bhaskar S, Hemavathy D, Prasad S. Prevalence of chronic insomnia in adult patients and its correlation with medical comorbidities. J Family Med Prim Care. 2016;5(4):780–4. doi: 10.4103/2249-4863.201153 28348990

2. Qaseem A, Kansagara D, Forciea MA, Cooke M, Denberg TD, Physicians Management of Chronic Insomnia Disorder in Adults: A Clinical Practice Guideline From the American College of Physicians Management of Chronic Insomnia Disorder in Adults. Ann Intern Med. 2016;165(2):125–33. doi: 10.7326/M15-2175 27136449

3. Kessler RC, Berglund PA, Coulouvrat C, Hajak G, Roth T, Shahly V, et al., Insomnia and the Performance of US Workers: Results from the America Insomnia Survey. Sleep. 2011 Sep 1; 34(9): 1161–1171.

4. Tefft BC AAA Foundation for Traffic Safety. Prevalence of Motor Vehicle Crashes Involving Drowsy Drivers, United States, 2009–2013 [457 KB] External.Washington, DC: AAA Foundation for Traffic Safety; 2014. October 19, 2015.

5. Schutte-Rodin S, Broch L, Buysse D, Dorsey C, Sateia M. Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med. 2008;4(5):487–504. PMCID: PMC2576317 18853708

6. DiPiro JT, Talbert RT, Yee GC, Matzke GR, Wells BG, Posey LM. Pharmacotherapy: A Pathophysiologic Approach, 10th Edition, 2017, McGraw-Hill Education.

7. Krinsky DL, Hemstreet B, Hume AL, Newton GD, Rollins CJ and Tietze KJ. Insomnia (chapter 46), In: Handbook of Nonprescription Drugs: An Interactiove Approach to Self-Care. 19th ed. Washington DC, AphA 2018. Can be obtained from URL: Last accessed on January 14th, 2019.

8. Bartlett DJ, Marshall NS, Williams A, Grunstein RR. Predictors of primary medical care consultation for sleep disorders. Sleep Med. 2008;9(8):857–64. doi: 10.1016/j.sleep.2007.09.002 17980655

9. Kashyap KC, Nissen LM, Smith SS, Kyle G. Management of over-the-counter insomnia complaints in Australian community pharmacies: a standardized patient study. Int J Pharm Pract. 2014;22(2):125–34. doi: 10.1111/ijpp.12052 23947610

10. Elayeh E, Akour A, Almadaeen S, AlQhewii T, Basheti IA. Practice of pharmaceutical care in community pharmacies in Jordan. Trop J Pharm Res. 2017;16(2):463–70. doi: 10.4314/tjpr.v16i2.27

11. Wazaify M, Al-Bsoul-Younes A, Abu-Gharbieh E, Tahaineh L. Societal perspectives on the role of community pharmacists and over-the-counter drugs in Jordan. Pharm World Sci. 2008;30(6):884. doi: 10.1007/s11096-008-9244-1 18683077

12. Mukattash TL, Bazzi NH, Nuseir KQ, Jarab AS, Abu-Farha RK, Khdour MR. Pharmaceutical care in community pharmacies in Jordan: a public survey. Pharm Pract (Granada). 2018;16(2):1126. doi: 10.18549/PharmPract.2018.02.1126 30023022

13. Shilbayeh SA. Exploring knowledge and attitudes towards counselling about vitamin supplements in Jordanian community pharmacies. Pharm Pract. 2011;9(4):242–51.:

14. Jaber D, Aburuz S, Hammad EA, El-Refae H, Basheti IA. Patients' attitude and willingness to pay for pharmaceutical care: An international message from a developing country. Res Social Adm Pharm. 2018. doi: 10.1016/j.sapharm.2018.10.002 30337178

15. AbuRuz S, Al‐Ghazawi M, Snyder A. Pharmaceutical care in a community‐based practice setting in Jordan: where are we now with our attitudes and perceived barriers? Int J Pharm Pract. 2012;20(2):71–9. doi: 10.1111/j.2042-7174.2011.00164.x 22416931

16. Almaaytah A, Mukattash TL, Hajaj J. Dispensing of non-prescribed antibiotics in Jordan. Patient Prefer Adherence. 2015;9:1389–95. doi: 10.2147/PPA.S91649 26491267

17. Hammad EA, Elayeh E, Tubeileh R, Watson M, Wazaify M. A simulated patient study assessing over the counter supply and counseling in Jordan: responding to headache complaints. Int J Clin Pharm. 2018;40(5):982–6. doi: 10.1007/s11096-018-0679-8 29967966

18. Kippist C, Wong K, Bartlett D, Saini B. How do pharmacists respond to complaints of acute insomnia? A simulated patient study. Int J Clin Pharm. 2011;33(2):237–45. doi: 10.1007/s11096-011-9482-5 21394573

19. Hussain A, Ibrahim MI, Malik M. Assessment of disease management of insomnia at community pharmacies through simulated visits in Pakistan. Pharm Pract. 2013;11(4):179. PMCID: PMC3869632

20. Berger K, Eickhoff C, Schulz M. Counselling quality in community pharmacies: implementation of the pseudo customer methodology in Germany. J Clin phar Ther. 2005;30(1):45–57. doi: 10.1111/j.1365-2710.2004.00611.x 15659003

21. Alte D, Weitschies W, Ritter CA. Evaluation of consultation in community pharmacies with mystery shoppers. Ann Pharmacother. 2007;41(6):1023–30. doi: 10.1345/aph.1H565 17519295

22. Abu Asab MIE, Abushams L, Albsoul-Younes A, Wazaify M. "A Decade in Leaps and Bounds": Pharmacy in Jordan- revisited. Jordan J Pharm Sci. 2019;12(3):51–61

23. Mesquita AR, Lyra DP Jr, Brito GC, Balisa-Rocha BJ, Aguiar PM, de Almeida Neto AC. Developing communication skills in pharmacy: a systematic review of the use of simulated patient methods. Patient Educ Couns. 2010;78(2):143–8. doi: 10.1016/j.pec.2009.07.012 19683890

24. Alenezi NA, Wazaify MM, Younes AA. Evaluation of Outpatient-Pharmacists' Counseling Behavior and Content in a Teaching Hospital in Jordan: An Observational Study. Jordan J Pharm Sci. 2014;108(3393):1–11. doi: 10.12816/0027097

25. Watson MC, Skelton JR, Bond CM, Croft P, Wiskin CM, Grimshaw JM, et al. Simulated patients in the community pharmacy setting–Using simulated patients to measure practice in the community Pharm World Sci. 2004;26(1):32–7. doi: 10.1023/b:phar.0000013467.61875.ce 15018257

26. Watson M, Norris P, Granas A. A systematic review of the use of simulated patients and pharmacy practice research. Int J Pharm Pract. 2006;14(2):83–93. doi: 10.1211/ijpp.14.2.0002

27. Matowe L, Abahussain E, Al-Saffar N, Bihzad S, Al-Foraih A, Al-Kandery A. Physicians’ perceptions and expectations of pharmacists’ professional duties in government hospitals in Kuwait. Med Princ Pract. 2006;15(3):185–9. doi: 10.1159/000092179 16651833

28. Wazaify M, Abood E, Tahaineh L, Albsoul-Younes A. Jordanian community pharmacists’ experience regarding prescription and nonprescription drug abuse and misuse in Jordan–An update. J Subst Use. 2017;22(5):463–8. doi: 10.1080/14659891.2016.1235734

29. Wazaify M, Scott J. Prescription/non-prescription medicine misuse and regulation–time for a modern, fit for purpose approach. Journal of Pharmacy Practice and Community Medicine (JPPCM). 2017;3(4):197–9. doi: 10.5530/jppcm.2017.4

30. Al-Husseini A, Abu-Farha R, Wazaify M, Van Hout MC. Pregabalin dispensing patterns in Amman-Jordan: An observational study from community pharmacies. Saudi Pharm J. 2018;26(3):306–10. doi: 10.1016/j.jsps.2018.01.012 29556121

31. Lenahan JL, McCarthy DM, Davis TC, Curtis LM, Serper M, Wolf MS. A drug by any other name: patients' ability to identify medication regimens and its association with adherence and health outcomes. J Health Commun. 2013;18(sup1):31–9. doi: 10.1080/10810730.2013.825671 24093343

32. Akour A, Kasabri V, Afifi FU, Bulatova N. The use of medicinal herbs in gynecological and pregnancy-related disorders by Jordanian women: a review of folkloric practice vs. evidence-based pharmacology. Pharm Biol. 2016;54(9):1901–18. doi: 10.3109/13880209.2015.1113994 26911517

33. Omeish AF, Abbadi W, Ghanma IM, Drabaa Z, Botoosh FA, Seif A, Massadeh M. Hospital-based study on the use of herbal medicine in patients with coronary artery disease in Jordan. J Pak Med Assoc. 2011;61(7):683–7. 22204246

34. Murphy AL, Martin-Misener R, Kutcher SP, Gardner DM. Pharmacists’ performance in a telephone-based simulated patient study after a mental health capacity-building program. Int J Clin Pharm. 2015;37(6):1009–13. doi: 10.1007/s11096-015-0171-7 26210258

35. Collins JC, Schneider CR, Wilson F, de Almeida Neto AC, Moles RJ. Community pharmacy modifications to non-prescription medication requests: a simulated patient study. Res Social Adm Pharm. 2018;14(5):427–33. doi: 10.1016/j.sapharm.2017.05.007 28552680

36. Obreli-Neto PR, Pereira LRL, Guidoni CM, de Oliveira Baldoni A, Marusic S, de Lyra-Júnior DP, et al. Use of simulated patients to evaluate combined oral contraceptive dispensing practices of community pharmacists. PLoS One. 2013;8(12):e79875. doi: 10.1371/journal.pone.0079875 24324584

Článek vyšel v časopise


2019 Číslo 12
Nejčtenější tento týden