International Journal of Clinical Pharmacy

, Volume 39, Issue 4, pp 759–768 | Cite as

Utilization of simulated patients to assess diabetes and asthma counseling practices among community pharmacists in Qatar

  • Bridget ParavattilEmail author
  • Nadir Kheir
  • Adil Yousif
Research Article


Background Patient counseling is one of the most important services a pharmacist can provide to patients. Studies have shown that counseling provided by pharmacists may prevent medication related problems and improve adherence to medication therapy. Objective To explore counseling practices among community pharmacists using simulated patients and to determine if patient, pharmacist, and pharmacy characteristics influence the counseling provided by community pharmacists. Setting Private community pharmacies within Qatar. Method This is a randomized, cross sectional study where simulated patients visited community pharmacies and presented the pharmacist with a new prescription or requested a refill for either a diabetes or asthma medication. Pharmacists completed a questionnaire at the end of the simulated interaction, which was utilized to determine if patient, pharmacist, or pharmacy characteristics had any influence on the counseling provided to patients. A scoring system was devised to assess the pharmacist’s counseling practices. Main outcome measure To evaluate the type of information provided by community pharmacists to the simulated patient regarding diabetes and asthma. Results One hundred and twenty-nine pharmacists were enrolled in the study. Eighty one percent of pharmacists had a score <35%. Medication name (95%), directions (47%), indication (43%), and dose (41%) were the most frequently counseled components by pharmacists during the simulated interaction. Male patients received better counseling compared to the female patients (t = 6.177; p < 0.0001). Pharmacists with a master of pharmacy degree provided significantly better counseling (f = 3.261; p = 0.042). Many pharmacists (65%) provided hypoglycemia management to patients, however, 63% referred the patient to the physician when the patient experienced hypoglycemia from inappropriate medication administration. Only 2 (7%) pharmacists correctly counseled the patient on all 8 inhaler administration steps. Majority of pharmacists (50%) educated on the role of the rescue and controller therapy in asthma, however, 33% referred the patient to the physician when the patient inquired about controller therapy use. Conclusion Patient counseling was substandard with the majority of community pharmacists focusing on the name of the medication. Pharmacists rarely assessed patient’s medical history or medication use. Disease management and problem solving skills of pharmacists were suboptimal with many referring patients back to the physician.


Asthma Community pharmacist Diabetes Patient counseling Qatar Simulated patients 



The authors wish to thank Ahmad Alkadour, Fahd Faleh, Hema Thulsidhos, and Manar Salem for devoting their time and effort as simulated patients during the data collection phase of this study.


Funding was made possible by the National Priorities Research Programme award [NPRP 4-254-3-080] from the Qatar National Research Fund (a member of The Qatar Foundation).

Conflicts of interest



  1. 1.
    Resnik DB, Ranelli PL, Resnik SP. The conflict between ethics and business in community pharmacy: what about patient counseling? J Bus Ethics. 2000;28:179–86.CrossRefPubMedGoogle Scholar
  2. 2.
    U.S. Food and Drug Administration. The FDA announces new prescription drug information format. Accessed 3 Jan 2016.
  3. 3.
    Karapinar-Carkit F, Borgsteede SD, Zoer J, Smit HJ, Egberts AC, van den Bemt PM. Effect of medication reconciliation with and without patient counseling on the number of pharmaceutical interventions among patients discharged from the hospital. Ann Pharmacother. 2009;43:1001–10.CrossRefPubMedGoogle Scholar
  4. 4.
    Schnipper JL, Kirwin JL, Cotugno MC, Wahlstrom SA, Brown BA, Tarvin E, et al. Role of pharmacist counseling in preventing adverse events after hospitalization. Arch Intern Med. 2006;166:565–71.CrossRefPubMedGoogle Scholar
  5. 5.
    Sarangarm P, London MS, Snowden SS, Dilworth TJ, Koselke LR, Sanchez CO, et al. Impact of pharmacist discharge medication therapy counseling and disease state education: pharmacist assisting at routine medical discharge (project PhARMD). Am J Med Qual. 2013;28:292–300.CrossRefPubMedGoogle Scholar
  6. 6.
    Khdour MR, Hallak HO. Societal perspectives on community pharmacy services in West Bank-Palestine. Pharm Pract. 2010;10:17–24.CrossRefGoogle Scholar
  7. 7.
    Hasan S, Sulieman H, Chapman CB, Stewart K, Kong DC. Community pharmacy services in the United Arab Emirates. Int J Pharm Pract. 2012;20:218–25.CrossRefPubMedGoogle Scholar
  8. 8.
    The Omnibus Budget Reconciliation Act of 1990. Pub. L. no. 101–508, 104 Stat 1388, § 4401.Google Scholar
  9. 9.
    Ministry of Development Planning and Statistics. Accessed 3 Jan 2016.
  10. 10.
    Kheir N, Fahey M. Pharmacy practice in Qatar: challenges and opportunities. South Med Rev. 2011;4:92–6.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Kheir N, Zaidan M, Younes H, El Hajj M, Wilbur K, Jewesson PJ. Pharmacy education and practice in 13 Middle Eastern countries. Am J Pharm Edu. 2009;72:1–13.Google Scholar
  12. 12.
    Paravattil B. Preceptors’ self-assessment of their ability to perform the learning objectives of an experiential program. Am J Pharm Edu. 2014;76:1–9.Google Scholar
  13. 13.
    Puspitasari HP, Aslani P, Krass I. A review of counseling practices on prescription medicines in community pharmacies. Res Soc Admin Pharm. 2009;5:197–210.CrossRefGoogle Scholar
  14. 14.
    Alaqeel S, Abanmy NO. Counselling practices in community pharmacies in Riyadh, Saudi Arabia: a cross-sectional study. BMC Health Serv Res. 2015;15:557.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Ibrahim MI, Palaian S, Al-Sulaiti F, El Shami S. Evaluating community pharmacy practice in Qatar using simulated patient method: acute gastroenteritis management. Pharm Pract (Granada). 2016;14(4):800.CrossRefGoogle Scholar
  16. 16.
    Merrett F. Reflections on the hawthorne effect. Educ Psychol. 2006;26:143–6.CrossRefGoogle Scholar
  17. 17.
    American Society of Health-System Pharmacists. ASHP guidelines on pharmacist-conducted patient education and counseling. Am J Hosp Pharm. 1997;54:431–4.Google Scholar
  18. 18.
    American Society of Consultant Pharmacists. Guidelines for pharmacist counseling of geriatric patients. Accessed 3 Jan 2016.
  19. 19.
    International Pharmaceutical Federation. Counselling concordance communication. Accessed 3 Jan 2016.
  20. 20.
    National Association of Pharmacy Regulatory Authorities. Guidelines of counselling. Accessed 3 Jan 2016.
  21. 21.
    Pharmaceutical Society of Australia. Professional practice standards 2010. Accessed 3 Jan 2016.
  22. 22.
    Wallman A, Vaudan C, Sporrong SK. Communications training in pharmacy education, 1995–2010. Am J Pharm Educ. 2013;77:36.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Bajis D, Chaar B, Penm J, Moles R. Competency-based pharmacy education in the Eastern Mediterranean region—a scoping review. Curr Pharm Teach Learn. 2016;8:401–28.CrossRefGoogle Scholar
  24. 24.
    Mesquita AR, Lyra DP, Brito GC, Balisa-Rocha BJ, Aquiar PM, de Almeida Neto AC. Developing communication skills in pharmacy: a systematic review of the use of simulated patient methods. Patient Educ Couns. 2010;78:143–8.CrossRefPubMedGoogle Scholar
  25. 25.
    Svarstad BL, Bultman DC, Mount JK. Patient counseling provided in community pharmacies: effects of state regulation, pharmacist age, and busyness. J Am Pharm Assoc. 2004;44:22–9.CrossRefGoogle Scholar
  26. 26.
    Kimberlin CL, Jamison AN, Linden S, Winterstein AG. Patient counseling practices in U.S. pharmacies: effects of having pharmacists hand the medication to the patient and state regulations on pharmacist counseling. J Am Pharm Assoc. 2011;51:527–34.CrossRefGoogle Scholar
  27. 27.
    Dameh M. Pharmacy in the United Arab Emirates. South Med Rev. 2009;2:15–28.PubMedPubMedCentralGoogle Scholar
  28. 28.
    El Hajj MS, Salem S, Mansoor H. Public’s attitudes towards community pharmacy in Qatar: a pilot study. Patient Prefer Adherence. 2011;5:405–22.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Hakonsen H, Lees K, Toverud EL. Cultural barriers encountered by Norwegian community pharmacists in providing service to non-Western immigrant patients. Int J Clin Pharm. 2014;36:1144–51.CrossRefPubMedGoogle Scholar
  30. 30.
    Komaric N, Bedford S, van Driel ML. Two sides of the coin: patient and provider perceptions of health care delivery to patients from culturally and linguistically diverse backgrounds. BMC Health Serv Res. 2012;12:322.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Kokanovic R, Furler J, May C, Dowrick C, Herrman H, Evert H, et al. The politics of conducting research on depression in a cross-cultural context. Qual Health Res. 2009;19:708–17.CrossRefPubMedGoogle Scholar
  32. 32.
    Basak SC, Sathyanarayana D. Pharmacy education in India. Am J Pharm Edu. 2010;74:1–8.CrossRefGoogle Scholar
  33. 33.
    Basheti IA, Qunaibi EA, Hamadi SA, Abu-Gharbieh E, Saleh S, AbuRuz S, et al. Patient perspectives of the role of the community pharmacist in the Middle East: Jordan, United Arab Emirates and Iraq. Pharmacol Pharm. 2014;5:588–99.CrossRefGoogle Scholar
  34. 34.
    Mabe AR, Rollin SA. The role of a code of ethical standards in counseling. J Couns Dev. 2011;64:294–7.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing 2017

Authors and Affiliations

  1. 1.Qatar UniversityDohaQatar

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