Assessment of Community Pharmacists' Performance in Managing Pediatric Fever and Pain: A Simulated Patient Study in Tehran

Abstract

Background: Community pharmacists are often the first line of defense in managing pediatric fever and pain; however, their ability to conduct a thorough clinical assessment in busy retail environments is rarely evaluated. Objectives: This study aimed to evaluate the real-world performance of pharmacists in Tehran and identify specific gaps in pediatric care. Methods: This descriptive-analytical, cross-sectional study used a simulated patient (SP) approach. A trained researcher visited 333 randomly selected pharmacies across all 22 districts of Tehran, while portraying the parent of a 2-year-old child weighing 12 kg with fever and ear pain. The researcher assessed spontaneous history-taking, the safety of drug recommendations, dosing accuracy, and the quality of advice using a validated 100-point scoring system. Results: Of the 295 evaluable pharmacists, most (51.2%) demonstrated moderate performance. A marked disparity was observed between technical skills and clinical communication. Although 97.3% recommended an appropriate first-line analgesic (ibuprofen or acetaminophen), the overall rate of appropriate management was 83.8% because 13.5% (40 pharmacists) inappropriately added diclofenac. In addition, 75.3% calculated the weight-based dose; however, initial clinical screening was often neglected. For example, pain intensity was assessed in only 20.6% of cases, and only 9.8% of pharmacists provided non-pharmacological advice. Urban community pharmacies significantly outperformed hospital-based pharmacies (P = 0.031), whereas age and gender had no significant effect on performance. Conclusions: The findings indicate that although pharmacists in Tehran possess strong technical pharmaceutical knowledge, they have substantial deficiencies in clinical assessment and patient-centered counseling. The frequent omission of non-pharmacological advice and the inappropriate use of second-line agents such as diclofenac highlight an urgent need for targeted clinical training to improve pediatric medication safety.