Pharmacist-led responses to headache and insomnia symptoms: A simulated patient study

This study investigated the practices of community pharmacists regarding two minor ailments, headache and insomnia, using a simulated patient (SP) method in Karaj, Iran. A trained pharmacy student, acting as an SP, visited pharmacies presenting with complaints of either headache or insomnia. Each simulation consisted of three steps: in Step 1, the SP explained the symptoms and waited for the pharmacist's recommendations; in Step 2, the SP requested medications; and in Step 3, the SP insisted on obtaining prescription-only drugs. A total of 200 pharmacies were surveyed; 100 were assigned to the headache scenario and 100 to the insomnia scenario. In the headache scenario, which required a referral to a physician, the pharmacists asked 26.4% of the patient history questions and addressed 9.4% of the physician referral criteria. Only 29 pharmacists (29.0%) referred the SP to a physician/imaging. Male pharmacists dispensed more prescription-only medications than female pharmacists (p = 0.03), whereas females were more likely to refer the SP to a physician (p = 0.02). In the insomnia scenario, which could be treated with nonprescription medications, the pharmacists asked 11.6% of the patient history questions and addressed 11.0% of the referral criteria. The most common recommendations in the first step were melatonin (52.0%), nonpharmacological interventions (18.0%), and herbal medicines (10.0%). Most pharmacists failed to obtain an adequate patient history, including physician referral criteria. In addition, the dosage, duration of therapy, and potential adverse drug reactions were not communicated to patients in most cases. The community pharmacists in this study demonstrated substantial deficiencies in history taking, contraindication screening, and patient counseling. These findings underscore the urgent need for targeted educational, regulatory, and practice-based interventions to enhance the quality and safety of over-the-counter care in Iran.