ArticleFrontiers in public health2026
Evaluating community pharmacists' practices in managing insomnia in Saudi Arabia: a cross-sectional study using simulated patient visits.
Article in Frontiers in public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Insomnia prevails globally and nationally as a serious public health issue with a global prevalence of 48% and is significantly linked to morbidity and productivity loss. Community pharmacists play a vital role in addressing the issue through over-the-counter (OTC) medications and lifestyle advice, yet insomnia management practices remain unexplored in Saudi Arabia. Hence, this study addresses the gap using a simulated patient (SP) methodology. Methods: A cross-sectional study employing SP was conducted to evaluate community pharmacists' approach to insomnia management across three regions of Saudi Arabia. A total of 251 visits were identified under the standard scenario. Data collected included pharmacist behavior, consultation duration, and recommendations. Data analysis included descriptive statistics, the chi-square test, Pearson correlation, and binary logistic regression to identify the predictors of pharmacists' history taking and patient counseling. Results: A total of 251 simulated visits to pharmacies were completed (urban area 43.4%, suburban area 49.4%, and rural 7.2%), consultation lasted for only 1.5 min (interquartile range [IQR] 1-2 min), most pharmacists inquired about sleep patterns (55.4%) and triggers (51%), recommended OTC medications (e.g., melatonin, 64.5%), and non-pharmacological advice were less frequent (9.6%). Safety information was infrequent (4.9%). Pharmacist professionalism was high (85.7%), but privacy, self-introduction, and referrals were low, with significant regional variation among pharmacies ( Discussion: Saudi pharmacists opted for safer OTC melatonin for the management of insomnia with brief consultation (IQR = 1-2 min), incomplete history taking, limited safety counseling (<5%), and rare non-pharmacological advice (9.6%). Regional variations and time pressures highlight the need for workflow improvements to enhance patient-centered care. The day of the visit displayed a strong effect (OR = 509.979), whereas longer pharmacist interactions were associated with lower odds of missing key questions (OR = 0.338). Accompanying symptoms (OR = 6567.348) and chronic health issues (OR = 941.751) were identified as strong predictors. Conclusion: Although pharmacists were accessible, gaps in insomnia management may risk patient safety. Targeted training for pharmacists (continuous professional development [CPD] programs), formulating community guidelines for pharmacists, and systemic changes are important to optimize their role in sleep health.
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