Using simulated patient methodology to assess sick day guidance in community pharmacy: The case of an elderly patient with diabetes

Background: Certain high-risk medication, such as diuretics, should be temporarily adjusted during sick days (diarrhoea, vomiting or fever) to reduce the risk of adverse drug events. Guidelines refer to this as ‘sick day guidance’. Prior research has shown limited awareness among pharmacy staff of these recommendations. Objective: This study assessed how community pharmacies in the Netherlands address a simulated self-care inquiry related to diarrhoea from a 71-year-old patient with diabetes. Methods: Three trained simulated informal caregivers visited community pharmacies unannounced to seek an antidiarrheal product for a 71-year-old family member with diabetes and high-risk medication. Data were collected through a data collection form with audio recording. Results: A total of 64 pharmacies were visited. Current comorbidities and medications were identified in 59 % (38/64) of the pharmacies. Sixteen out of 64 pharmacies (25 %) provided sick day guidance either through temporary medication adjustment or GP referral. In more than 80 % of the pharmacies, a pharmaceutical product was dispensed, most often loperamide. The pharmacies that did not identify current comorbidities and medications (n = 26), did not provide sick day guidance nor referred to the GP. Conclusions: Sick day guidance was applied in one in four cases. Identifying current comorbidities and medications is essential for providing sick day guidance.