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      Assessing hormonal contraceptive dispensing and counseling provided by community pharmacists in the United Arab Emirates: a simulated patient study

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          Abstract

          Background:

          Hormonal contraceptive pills have evolved as a common form of contraception worldwide. Pharmacists play a vital role in providing safe and effective access to these medicines. In many developing countries such as the United Arab Emirates (UAE), these medicines are available to the general public without the presentation of a prescription which requires the pharmacist to shoulder responsibility by assessing and educating patients to assure their appropriate use.

          Objectives:

          To evaluate community pharmacists’ current practice of dispensing and counseling on hormonal contraceptives

          Methods:

          Simulated patient methodology was used in this study. A single simulated patient visited community pharmacies requesting an oral contraceptive as per a preplanned scenario. Information from the visits were recorded on a data collection form including: pharmacist assessing patient eligibility to take hormonal contraceptives, selecting the appropriate oral contraceptive, providing complete counseling on how to use the pill, adherence, missed dose handlings and side effects of the medication. The Pharmacist was prompted by the simulated patient to provide the information if they did not provide spontaneous counseling. The quality of pharmacists’ counseling was rated and consequently coded as complete, incomplete or poor.

          Results:

          A total of 201 community pharmacies were visited. More than 92% of the pharmacists did not ask the simulated patient any question to assess their eligibility to use contraceptives. Twenty three pharmacists (11.4%) selected the proper product. One hundred seventeen (58.2%) of the pharmacists provided spontaneous counseling on how to use the pill, 17 of them had their counsel rated as complete, but none of the pharmacists provided spontaneous counseling regarding adherence or side effects of the medications. On prompting, 10 pharmacists (12%) provided complete counseling regarding how to use oral contraceptives, 14 pharmacists (7.0%) provided complete counseling on adherence and missing dose handling and five pharmacists (2.5%) provided complete counseling about expected side effects.

          Conclusions:

          Pharmacists’ practice regarding hormonal contraceptive dispensing and counseling was suboptimal in this study. Areas needing intervention were related to pharmacist assessment of eligibility for oral contraceptive use, choice of optimal oral contraceptive for patient-specific co-morbidities and provision of adequate counseling regarding proper use, adherence and missed dose handlings.

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          Most cited references25

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          The use of simulated patients in medical education: AMEE Guide No 42.

          Medical training has traditionally depended on patient contact. However, changes in healthcare delivery coupled with concerns about lack of objectivity or standardization of clinical examinations lead to the introduction of the 'simulated patient' (SP). SPs are now used widely for teaching and assessment purposes. SPs are usually, but not necessarily, lay people who are trained to portray a patient with a specific condition in a realistic way, sometimes in a standardized way (where they give a consistent presentation which does not vary from student to student). SPs can be used for teaching and assessment of consultation and clinical/physical examination skills, in simulated teaching environments or in situ. All SPs play roles but SPs have also been used successfully to give feedback and evaluate student performance. Clearly, given this potential level of involvement in medical training, it is critical to recruit, train and use SPs appropriately. We have provided a detailed overview on how to do so, for both teaching and assessment purposes. The contents include: how to monitor and assess SP performance, both in terms of validity and reliability, and in terms of the impact on the SP; and an overview of the methods, staff costs and routine expenses required for recruiting, administrating and training an SP bank, and finally, we provide some intercultural comparisons, a 'snapshot' of the use of SPs in medical education across Europe and Asia, and briefly discuss some of the areas of SP use which require further research.
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            Risk of ischaemic stroke in people with migraine: systematic review and meta-analysis of observational studies.

            To explore the association between migraine and risk of ischaemic stroke. Systematic review and meta-analysis. Observational studies published between 1966 and June 2004 (identified through Medline and Embase) that examined the association between migraine and risk of ischaemic stroke. 14 studies (11 case-control studies and 3 cohort studies) were identified. These studies suggest that the risk of stroke is increased in people with migraine (relative risk 2.16, 95% confidence interval 1.89 to 2.48). This increase in risk was consistent in people who had migraine with aura (relative risk 2.27, 1.61 to 3.19) and migraine without aura (relative risk 1.83, 1.06 to 3.15), as well as in those taking oral contraceptives (relative risk 8.72, 5.05 to 15.05). Data from observational studies suggest that migraine may be a risk factor in developing stroke. More studies are needed to explore the mechanism of this potential association. In addition, the risk of migraine among users of oral contraceptives must be further investigated.
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              A systematic review of the use of simulated patients and pharmacy practice research

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                Author and article information

                Contributors
                Journal
                Pharm Pract (Granada)
                Pharm Pract (Granada)
                Pharmacy Practice
                Centro de Investigaciones y Publicaciones Farmaceuticas
                1885-642X
                1886-3655
                Apr-Jun 2019
                11 June 2019
                : 17
                : 2
                : 1465
                Affiliations
                College of Pharmacy & Health Sciences, Ajman University . Ajman (United Arab Emirates). dalal.mobarak7@ 123456gmail.com
                Department of Pharmaceutical Sciences, College of Pharmacy & Health Sciences , Ajman University. Ajman (United Arab Emirates). m.altabakha@ 123456ajman.ac.ae
                Department of Clinical Sciences, College of Pharmacy & Health Sciences , Ajman University. Ajman (United Arab Emirates). s.hasan@ 123456ajman.ac.ae
                Author information
                http://orcid.org/0000-0001-7621-218X
                http://orcid.org/0000-0001-6425-3582
                http://orcid.org/0000-0002-3043-0322
                Article
                pharmpract-17-1465
                10.18549/PharmPract.2019.2.1465
                6594436
                eb411ee5-9e17-4c79-b628-b5fffebdb037
                Copyright: © Pharmacy Practice

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY-NC-ND 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 05 February 2019
                : 26 May 2019
                Categories
                Original Research

                contraceptive agents,contraception,counseling,professional practice,community pharmacy services,pharmacies,pharmacists,quality of health care,patient simulation,united arab emirates

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