Quality of assessment and counselling offered by community pharmacists and medication sale without prescription to patients presenting with acute cardiac symptoms: a simulated client study

Purpose Self-medication is common worldwide. However, the prevalence of sale of prescription medications without prescription and the quality of assessment and counselling provided by community pharmacists to cardiac patients is unknown. We sought to determine the prevalence of prescription medication sales and explore how pharmacists assess and counsel patients with acute cardiac conditions. Methods Six hundred community pharmacies in the two largest cities in Saudi Arabia were selected. Two simulated clients presented either an acute coronary syndrome (ACS) scenario or an acute heart failure (AHF) scenario to the pharmacists. Descriptive statistics and regression models were used to analyse and present the collected data. Results Of 600 pharmacies, 379 (63.2 %) sold various prescription medications to simulated patients without prescription. Assessment and counselling provided by pharmacists were inadequate. Almost a quarter of pharmacists did not ask simulated patients any questions; 52 % asked one or two questions; and only 24 % asked three or more questions. Only 28 pharmacists (4.7 %) inquired about drug allergies; 48.5 % instructed simulated patients on the dosage and frequency of the sold medications; 21.6 % provided instruction on treatment duration; and 19.4 % gave instructions on dose, frequency, and duration of treatment. Compared to AHF, ACS simulated patients were more likely to be asked about other symptoms and comorbidities (59.7 % vs. 48.7 %, p = 0.007 and 46.3 % vs. 37.3 %, p = 0.005, respectively) and were more likely to be advised to go to hospital (70.3 % vs. 56.3 %, p