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Table 1 Description of vignettes re-enacted at the pharmacies by the simulated patients

From: Drug therapy-related problem management in Nigeria community pharmacy – process evaluation with simulated patient

Vignette 1

Background

Prescription/Medications

Medical and medication history

The patient experienced stomach pain at night for over 2 weeks and had a fungal infection in between the toes. He claimed to have a low blood level and pain on the right side of his chest when he inhales. He had been coughing for a week. His physician diagnosed anaemia, pleurisy, duodenal ulcer, and Tinea pedis. He presented the following prescription to the pharmacist.

Prescription presented to the pharmacist at each pharmacy.

Name: TJB

Gender: Male

Age: 23 yrs

Rx

Tab. Fluconazole 150 mg q12hr ×  2/52

Tab. Ciprofloxacin 500 mg q12hr ×  3/52

Tab. Omeprazole 20 mg nocte ×  2/52

Tab. Ferrous gluconate 300 mg q8hr ×  2/52

The simulated patient presented the prescription to the pharmacist and identified that he is the owner. He informed the pharmacists of the physician diagnoses but would like to know if any of the drugs would cause him any harm as he does not like taking medications. If the pharmacist expresses concern about the prescription and would like to speak with his physician, the simulated patient was to provide the contact number of SJS who would clarify the concern of the pharmacist. If the pharmacists refused to dispense the medications, the simulated patient must ask why? but if the pharmacist chose to dispense them the simulated patient must buy the medications. If asked of any known allergy, the SP would answer that he has no allergy.

Vignette 2

Background

Prescription/Medications

Medical and medication history

A 45-year-old semiliterate young male took his medications to the pharmacist to help identify if his medications or his diseases were responsible for his weakness. He has type 2 diabetes and hypertension. He was feeling weak and dizzy for the last 3 days and sometimes felt like fainting. His fasting blood glucose level and blood pressure were 60 mg/dL and 126/79 mmHg, respectively that morning before coming to see the pharmacist. The following medications were what he brought to show the pharmacist.

Tab. Diamet® (Glibenclamide 5 mg) q24hr

Tab. Lisinopril 10 mg q24hr

Tab. Clamide® (Glibenclamide 5 mg) q24hr

Syr. Coflin Linctus® 15 ml q6hr

Tab. Metformin 1000 mg q12hr

Tab. Diclofenac 100 mg q24hr

He asked to speak with the pharmacist only and expressed his concern. He gave his medication pack to the pharmacist and informed him of his medical conditions. If the pharmacist asked why he was taking Diamet® and Clamide®, brands of glibenclamide, together, the SP claimed that his wife bought Clamide® for him with other drugs, but he had been using Diamet®. He did not know they were the same drug. If the pharmacist asked why he was using Coflin Linctus® and ibuprofen, he responded that he had a dry cough and his knees hurt. He bought the two drugs when his friend recommended them.

Vignette 3

Background

Prescription/Medications

Medical and medication history

A 37-year-old female took the prescription below to the pharmacy. She is a known hypertensive and gastric ulcer patient.

Name: MN

Gender: Female

Age: 37 years

Rx

Tab. Hydrochlorothiazide 25 mg q12hr ×  1/12

Tab. Amlodipine 10 mg daily ×  1/12

Tab, Aspirin 75 mg daily ×  1/12

Tab. Omeprazole 20 mg q12hr ×  1/12

Tab. Furosemide 40 mg q24hr ×  1/12

Tab. Clopidogrel 75 mg q24hr ×  1/12

She wanted to buy the medications but asked to speak with the pharmacist first and she informed the pharmacist that she is hypertensive and has gastric ulcer. She claim that it was her second prescription for her condition. She was diagnosed a month ago and her blood pressure at the hospital this morning was 153/92 mmHg. She told the pharmacist that she has not been taking her medications as she should and that she is willing to cooperate now that her blood pressure is not well controlled. She provided the pharmacists with other relevant information when asked, such as her allergies and that she has no other known medical condition or oedema. She wants the pharmacist to counsel her. If the pharmacist is concerned about her medications and wanted to speak with her physician, she provided the contact number of the pseudo-physician who is one of the authors (SJS). SJS addressed the concern of the pharmacist such as the withdrawal of furosemide when the patient had no oedema and the removal of Aspirin and the modification of the frequency of use of Hydrochlorothiazide if any of the pharmacists suggested these.

  1. Calcimax® – contain Calcium carbonate, Magnesium hydroxide, Zinc sulphate and Vitamin D3; Coflin Lintus® – contain Chlorpheniramine maleate, Ammonium Chloride, Sodium citrate, Menthol and Ephedrine hydrochloride.