Assessing the referral of clients with respiratory symptoms to general physicians: a survey of community pharmacists in Beirut.

Abstract

The main objective of this study was to assess the ability of community pharmacists practicing in Beirut to identify red flag respiratory symptoms, and therefore to adequately refer clients to a general physician when warranted. Secondary objectives included determining whether demographic factors affect the odds of referral, and to qualify degree of agreement of community pharmacists with a panel of expert physicians. In this cross-sectional study, pharmacies were randomly selected and invited to complete a self-administered survey, each containing 10 clinical vignettes that combined different characteristics (age group, gender, presenting symptom, duration of symptoms). Bivariate and multivariate logistic regressions were used to inspect predictors of referral, correct referral and under-referral. A total of 214 pharmacies were visited and 141 (65.9%) responded. Pharmacists were more likely to refer female patients (P=0.035) and patients who presented with a longer duration of symptoms (P<0.001). Correct referral was higher in pharmacies that were more than 20min away from the nearest hospital (P=0.013) and with clients who presented with haemoptysis (P<0.001), dyspnoea (P<0.001) or wheezing (P<0.027), while it was lower with female patients (P<0.001). Under-referral was higher in pharmacies that served more than 500 clients weekly (P=0.048) and in patients presenting for dry cough (P<0.001) or productive cough (P<0.001). This study has shown that there is a need for further investigation into the practices of community pharmacists of Beirut. An action plan may be advised to alleviate the burden of patients who might currently be under-referred and experience morbidity as a result.