Dispensing of antibiotics for tuberculosis patients using standardized patient approach at community pharmacies: results from a cross-sectional study in Pakistan

Ali Hassan Gillani; Hafsa Arshad; Hasan Mujtaba; Muhammad Farooq Umer; Sen Xu; Wenjing Ji; Kamran Bashir; Jie Chang; Caijun Yang; Yu Fang

doi:10.3389/fpubh.2023.1241551

Dispensing of antibiotics for tuberculosis patients using standardized patient approach at community pharmacies: results from a cross-sectional study in Pakistan

Front Public Health. 2024 Jan 8:11:1241551. doi: 10.3389/fpubh.2023.1241551. eCollection 2023.

Authors

Ali Hassan Gillani^{1

2

3}, Hafsa Arshad^{1

2

3}, Hasan Mujtaba⁴, Muhammad Farooq Umer⁵, Sen Xu^{1

2

3}, Wenjing Ji^{1

2

3}, Kamran Bashir⁶, Jie Chang^{1

2

3}, Caijun Yang^{1

2

3}, Yu Fang^{1

2

3}

Affiliations

¹ Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China.
² Center for Drug Safety and Policy Research, Xian Jiaotong University, Xi'an, Shaanxi, China.
³ Shaanxi Centre for Health Reform and Development Research, Xi'an, Shaanxi, China.
⁴ Department of Pathology, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan.
⁵ College of Dentistry, King Faisal University, Hofuf, Alahsa, Saudi Arabia.
⁶ College of Pharmacy, University of Sargodha Pakistan, Sargodha, Pakistan.

Abstract

Background: Pakistan is among top countries for antibiotic consumption around the globe and patients often receive antibiotics directly from community pharmacies. Thus, our aim was to assess the drug dispensing practices of pharmacies for presumed and confirmed tuberculosis by using standardized patients' method in Pakistan.

Methods: In this cross-sectional study, we adopted two standardized patient cases in pharmacies of three cities of Punjab. The first case involved a presumed tuberculosis patient presenting with 2-3 weeks of cough and fever (Case-1), and the second case involved a confirmed tuberculosis patient carrying microbiologically confirmed tuberculosis results (Case-2). The ideal management for Cases-1 and Case-2 is referral of standardized patients to a healthcare provider without dispensing antibiotics or steroids, or both. The differences in antibiotic use, steroid use, and the number of medicines dispensed in referred and non-referred patients between Case-1 and Case-2 were analyzed using descriptive statistics.

Results: Between April 1, 2020, and July 31, 2020, standardized patients completed 575 out of 598 interactions among community pharmacies in Lahore, Rawalpindi, and Sialkot. We recorded ideal management in 115 (37.7%) of the 305 Case-1 interactions and 130 (48.1%) of the 270 Case-2 interactions. Antibiotic dispensing was higher in Case-1, with 71 out of 305 instances (23.3%), than in Case-2 interactions, with 27 out of 270 instances (10.0%). Anti-tuberculosis drugs were dispensed to 1 patient in Case-1 (0.3%) and to 19 patients (7.0%) in Case-2.

Conclusion: Slightly more than one-third of pharmacies in Punjab, Pakistan, ideally managed patients with presumed tuberculosis, but almost half of them ideally managed cases of confirmed tuberculosis. The presence of confirmed diagnosis slightly changes the behavior in the correct management of patients.

Keywords: community pharmacies; dispensing of antibiotics; dispensing practices; simulated client approach; tuberculosis patients.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Antitubercular Agents / therapeutic use
Cross-Sectional Studies
Humans
Pakistan
Pharmacies*
Tuberculosis* / drug therapy

Substances

Antitubercular Agents

Grants and funding

This research was funded by the National Natural Science Fund (71974156) and the “High Achiever Plan,” “Young Talent Support Plan” of Health Science Center, Xi’an Jiaotong University.