ASSESSMENT OF HYPOGLYCEMIA MANAGEMENT PRACTICES IN COMMUNITY PHARMACIES: A STANDARDISED PATIENT STUDY
Author(s)
Zuha Shyma, PharmD1, Sonal Sekhar, M Pharm, PhD2, Chythra R Rao, MBBS, MD, DNB3, Girish Thunga, M Pharm, PhD4, Sreedharan Nair, M Pharm, PhD5.
1Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal, India, 2Manipal College of Pharmaceutical Sciences, Manipal, India, 3Department of Community medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Manipal, India, 4Manipal college of pharmaceutical sciences, Manipal, India, 5Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal, Karnataka, India.
1Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal, India, 2Manipal College of Pharmaceutical Sciences, Manipal, India, 3Department of Community medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Manipal, India, 4Manipal college of pharmaceutical sciences, Manipal, India, 5Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal, Karnataka, India.
OBJECTIVES: To compare hypoglycaemia management by community pharmacists using standardised patient (SP) and self-assessment questionnaire (SAQ) methods.
METHODS: A point-prevalence survey was conducted in 115 community pharmacies (proportionally sampled from 7 sub-districts) from November 2025 to May 2026 using the SAQ method. A trained SP visited the same pharmacies using the scenario: “I feel my dad has trouble managing diabetes. His blood sugar levels remain high; sometimes, he feels tired, sweats, and shivers. What should be done?”. Two independent raters coded each encounter using a prespecified 15-item binary checklist (Patient Assessment-4items; Clinical Recognition and Management-4 items; Referral Quality-2 items; Inappropriate Actions-4 items). Inter-rater agreement was high for these items (median kappa (κ) = 1.00 [0.74 - 1.00]). Observed practice was compared with pharmacists' SAQ responses (McNemar tests).
RESULTS: Hypoglycaemia was recognised in 27% of encounters, and 16% advised to consume a fast-acting carbohydrate. Referral to a physician was common (77%), while glucose levels were enquired in 24%. An unindicated Over the Counter (OTC) and a prescription medicine were attempted to dispense in 33% and 1.7% of encounters, respectively. Using Bloom's cut-off, overall practice was poor in 46.95%, fair in 40%, and good in 13.05%. Whereas the SAQ method overstated observed practice: adherence assessment was self-reported by 37.7% but observed in 5.2% (p < 0.001; κ = 0.03), and counselling was reported by 40.3% but observed in 9.1% (p < 0.001; κ = 0.13).
CONCLUSIONS: Pharmacists’ diabetes care practices are usually assessed using SAQs, which may not reflect actual practice. The SP method is the gold standard for assessing real-world practice. Hypoglycemia case management by a community pharmacist was often inadequate in our findings. A substantial gap was identified between self-reported and actual practice in diabetes care delivery. The findings support the feasibility of the SP method for evaluating real-world practices.
METHODS: A point-prevalence survey was conducted in 115 community pharmacies (proportionally sampled from 7 sub-districts) from November 2025 to May 2026 using the SAQ method. A trained SP visited the same pharmacies using the scenario: “I feel my dad has trouble managing diabetes. His blood sugar levels remain high; sometimes, he feels tired, sweats, and shivers. What should be done?”. Two independent raters coded each encounter using a prespecified 15-item binary checklist (Patient Assessment-4items; Clinical Recognition and Management-4 items; Referral Quality-2 items; Inappropriate Actions-4 items). Inter-rater agreement was high for these items (median kappa (κ) = 1.00 [0.74 - 1.00]). Observed practice was compared with pharmacists' SAQ responses (McNemar tests).
RESULTS: Hypoglycaemia was recognised in 27% of encounters, and 16% advised to consume a fast-acting carbohydrate. Referral to a physician was common (77%), while glucose levels were enquired in 24%. An unindicated Over the Counter (OTC) and a prescription medicine were attempted to dispense in 33% and 1.7% of encounters, respectively. Using Bloom's cut-off, overall practice was poor in 46.95%, fair in 40%, and good in 13.05%. Whereas the SAQ method overstated observed practice: adherence assessment was self-reported by 37.7% but observed in 5.2% (p < 0.001; κ = 0.03), and counselling was reported by 40.3% but observed in 9.1% (p < 0.001; κ = 0.13).
CONCLUSIONS: Pharmacists’ diabetes care practices are usually assessed using SAQs, which may not reflect actual practice. The SP method is the gold standard for assessing real-world practice. Hypoglycemia case management by a community pharmacist was often inadequate in our findings. A substantial gap was identified between self-reported and actual practice in diabetes care delivery. The findings support the feasibility of the SP method for evaluating real-world practices.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HSD5
Topic
Epidemiology & Public Health, Health Service Delivery & Process of Care, Methodological & Statistical Research
Disease
Diabetes/Endocrine/Metabolic Disorders (including obesity), No Additional Disease & Conditions/Specialized Treatment Areas