Insomnia Management in Community Pharmacies of Tripoli, Libya: A Simulated Patient Assessment of Counseling Practices

الملخص

Background: As the first point of contact for many with sleep problems, community pharmacists (CPS) play a key role in managing acute insomnia. This study evaluates the counselling and management practices of CPs in Tripoli-Libya; regarding this condition, an area where evidence remains scarce.

Methods: A cross-sectional study was conducted using the simulated patient (SP) methodology. A trained female SP presented a standardized case of acute, stress-related insomnia at 275 randomly selected community pharmacies in Tripoli. Data on history-taking, recommendations, and counselling were collected via a structured form and audio recordings, which were analyzed using descriptive statistics.

Results: A product was dispensed or recommended in 83.3% of visits. History-taking was inconsistent; while most pharmacists inquired about symptom nature (95.3%) and duration (62.9%), critical safety checks for concomitant medications (37.5%), medical conditions (9.8%), and allergies (2.2%) were frequently omitted. Melatonin supplements (44.4%), sedating antihistamines (25.5%), and magnesium (18.5%) were the most common recommendations. Inappropriate supply of prescription-only benzodiazepines occurred in 1.1% of cases. Counselling was deficient: while 80.4% provided dosing instructions, information on frequency (45.5%), duration (43.3%), and potential side effects (7.3%) was often lacking. Non-pharmacological advice was limited, with 45.8% advising caffeine reduction. The mean consultation time was brief (1 minute, 37.4 seconds), and an empathetic communication style was observed in only 8.7% of encounters.

Conclusion: The management of acute insomnia in Libyan pharmacies is inadequate, favoring product supply over patient counselling and safety. This underscores an urgent need for educational programs, structured protocols, and regulatory reinforcement to improve care.