title: Use of simulated patients to evaluate combined oral contraceptive dispensing practices of community pharmacists.
abstract: BACKGROUND
  Combined oral contraceptive (COC) use is the most commonly used reversible method of birth control. The incorrect use of COCs is frequent and one of the most common causes of unintended pregnancies. Community pharmacists (CPs) are in a strategic position to improve COC use because they are the last health professional to interact with patients before drug use.
  
  
  OBJECTIVE
  To evaluate the COC dispensing practices of CPs in a developing country.
  
  
  METHODS
  A cross-sectional study was conducted in community pharmacies of Assis and Ourinhos microregions, Brazil, between June 1, 2012, and October 30, 2012. Four simulated patients (SPs) (with counseled audio recording) visited community pharmacies with a prescription for Ciclo 21(®) (a COC containing ethinyl estradiol 30 mcg + levonorgestrel 15 mcg). The audio recording of every SP visit was listened to independently by 3 researchers to evaluate the COC dispensing practice. The percentage of CPs who performed a screening for safe use of COCs (i.e., taking of patients' medical and family history, and measuring of blood pressure) and provided counseling, as well as the quality of the screening and counseling, were evaluated.
  
  
  RESULTS
  Of the 185 CPs contacted, 41 (22.2%) agreed to participate in the study and finished the study protocol. Only 3 CPs asked the SP a question (1 question asked by each professional), and all of the questions were closed-ended, viz., "do you smoke?" (n = 2) and "what is your age?" (n = 1). None of the CPs measured the patient's blood pressure. Six CPs provided counseling when dispensing COCs (drug dosing, 5 CPs; possible adverse effects, 2 CPs), and one CP provided counseling regarding both aspects.
  
  
  CONCLUSIONS
  The CPs evaluated did not dispense COC appropriately and could influence in the occurrence of negatives therapeutic outcomes such as adverse effects and treatment failure.
authors: Department of Pharmacology and Therapeutics, State University of Maringa, Maringa, Brazil.
authors: Paulo Roque
authors: PR
authors: Obreli-Neto
authors: Leonardo Régis Leira
authors: LR
authors: Pereira
authors: Camilo Molino
authors: CM
authors: Guidoni
authors: André
authors: A
authors: de Oliveira Baldoni
authors: Srecko
authors: S
authors: Marusic
authors: Divaldo Pereira
authors: DP
authors: de Lyra-Júnior
authors: Kelsen Luis
authors: KL
authors: de Almeida
authors: Ana Claudia Montolezi
authors: AC
authors: Pazete
authors: Janaina Dutra
authors: JD
authors: do Nascimento
authors: Mitja
authors: M
authors: Kos
authors: Edmarlon
authors: E
authors: Girotto
authors: Roberto Kenji Nakamura
authors: RK
authors: Cuman
mesh_terms: D000328:Adult; D001938:Brazil; D002983:Clinical Competence / Q000706:statistics & numerical data; D003267:Contraception / Q000706:statistics & numerical data; D003277:Contraceptives, Oral, Combined / Q000600:supply & distribution*; D003376:Counseling / Q000941:ethics; D004997:Ethinyl Estradiol / Q000600:supply & distribution*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016912:Levonorgestrel / Q000600:supply & distribution*; D008297:Male; D016544:Patient Simulation; D010595:Pharmacists / Q000941:ethics* / Q000523:psychology
chemical_list: D003277:Contraceptives, Oral, Combined; D004997:Ethinyl Estradiol; D016912:Levonorgestrel