Community Pharmacy Staff Referral of Patients with Diarrhea to Medical Consultation: A Simulated Patient Study

The objectives were (i) to assess the ability of community pharmacy staff in Jordan to identify diarrhea symptoms suggestive of bacterial gastroenteritis and advise patients to see a physician and (ii) to identify the factors influencing the referral decisions.

The study used the simulated patient (SP) approach. Four SPs conveyed a symptom-based scenario of bacterial gastroenteritis. Each visit was assessed for three outcomes: appropriateness of the visit outcome (i.e. referral decision), pharmacist's information gathering behavior, and pharmacist's professional behavior. Factors influencing the referral behavior, information content, and professional behavior were also investigated.

Sixty-one visits were conducted. For 52 (85%) visits, the SP was referred to a physician. This was spontaneous in 35 visits (57%) and prompted by the SP in 17 visits (28%). For 24 (39%) visits, the pharmacy staff unnecessarily dispensed an antibiotic. Younger pharmacy staff, those located in Amman, and those working during afternoon shifts were more likely to refer patients (all P-value < .05). A significant correlation was found between the referral score and the information gathering behavior (P = .014).

The failure to identify the need to refer SPs with symptoms suggestive of a serious illness may result in treatment delays and compromised patient safety. The dispensing of unnecessary antibiotics can increase antimicrobial resistance. Further actions are required to optimize patient management in community pharmacy settings.