Community pharmacy modifications to non-prescription medication requests: A simulated patient study

The simulated patient method: Design and application in health services research

The simulated patient method is becoming increasingly popular in health services research to observe the behaviour of healthcare practitioners in a naturalistic setting. This method involves sending a trained individual (simulated patient among other names), who is indistinguishable from a regular consumer, into a healthcare setting with a standardised scripted request. This paper provides an overview of the method, a brief history of its use in health services research, comparisons with other methods, ethical considerations, and considerations for the development of studies using the simulated patient method in health services research, with examples from pharmacy and other fields. Methods of analysis, mixed-methods, and the use of simulated patients with feedback are also discussed.

Impact of a blended learning program on community pharmacists' barriers, knowledge, and counseling practice with regard to preconception, pregnancy and lactation

BACKGROUND

Community pharmacists acknowledge to have an important role in providing pharmaceutical care during preconception, pregnancy and lactation. However, pharmacists' knowledge and counseling regarding this topic is still insufficient. Hence, educational initiatives are urgently needed.

OBJECTIVES

To assess the impact of a blended learning program ('intervention') on community pharmacists' barriers, knowledge, and counseling practice with regard to preconception, pregnancy and lactation.

METHODS

A pre-post study was performed in collaboration with 40 randomly selected pharmacies belonging to a large pharmacy chain in Belgium. All pharmacists employed in these pharmacies were eligible to participate in a blended learning program consisting of an e-learning and an on-site training day. Data were collected using online surveys, mystery shopping visits and pharmacy records. Pharmacy conversations were assessed on information gathering, dispensed product, and case-specific information. A retention knowledge test was completed 3-6 months after the intervention.

RESULTS

In total, 60 pharmacists completed the post-intervention surveys (response rate: 95%). The total number of barriers decreased after the intervention, while organizational barriers such as lack of privacy (73%) and lack of time (67%) became more prevalent. Pharmacists' short and long-term knowledge improved after the intervention (p ≤ 0.001), although knowledge declined again over time (p ≤ 0.001). During counseling, pharmacists more often spontaneously provided information about folic acid when dispensing a pregnancy test, and more often suggested the correct dose/dosage for the dispensed OTC-product against pregnancy-related nausea. However, poor information gathering, dosing errors and incomplete information were still observed.

CONCLUSION

The blended learning decreased pharmacists' barriers and improved their short- and long-term knowledge, while counseling practice only partially improved. Hence, the blended learning was insufficient to enhance pharmacists' information gathering competences and to fully implement pharmaceutical care services with regard to preconception, pregnancy and lactation.

Assessing insomnia management in community pharmacy setting in Jordan: A simulated patient approach

Insomnia is one of the most common minor ailments to which patients seek advice in a community pharmacy setting. Due to the availability of a wide variety of over-the-counter (OTC) products, community pharmacists are in the front line to safe-guard patients looking for self-medication or advice for treatment of insomnia. The purpose of this study was to assess the content of community pharmacists' interactions with patients seeking advice for insomnia in Jordan. A cross-sectional study using a simulated patient methodology was conducted across a stratified convenience sample of community pharmacies in three major cities in Jordan. The visits were evaluated using pre-defined criteria adapted from published literature relating to content and counseling skills. Visits were audio-recorded using a hidden microphone and the simulated patient completed a data collection form immediately after each visit. A total of 67 community pharmacies (response rate = 93.0%) agreed to participate and were all visited once by the simulated patient. The median duration of the visit was 2 minutes (range: 0.2-4 minutes). The majority (86.6%) of visits resulted in the sale of a drug, most commonly a combination product (paracetamol and diphenhydramine) for 30 recommendations (44.8%). This was followed by a natural plant extract combination product, namely valerian and lemon balm (Melissa officinalis L.) for 23 (34.3%). Pharmacists often did not question medical history or other symptoms prior to product sale. Frequently, the recommended dose (49.3%) and administration time (38.8%) were the only information provided to the patient. No information was provided in relation to potential drug interactions or contraindications. No advice was offered on lifestyle or good sleeping hygiene. This study provided evidence that community pharmacists in Jordan in general did not offer adequate counseling for patients seeking advice for insomnia. Exploration of the reasons and factors contributing to this practice and highlighting professional opportunity and responsibility is recommended.

ARIA pharmacy 2018 "Allergic rhinitis care pathways for community pharmacy": AIRWAYS ICPs initiative (European Innovation Partnership on Active and Healthy Ageing, DG CONNECT and DG Santé) POLLAR (Impact of Air POLLution on Asthma and Rhinitis) GARD Demonstration project

Pharmacists are trusted health care professionals. Many patients use over-the-counter (OTC) medications and are seen by pharmacists who are the initial point of contact for allergic rhinitis management in most countries. The role of pharmacists in integrated care pathways (ICPs) for allergic diseases is important. This paper builds on existing studies and provides tools intended to help pharmacists provide optimal advice/interventions/strategies to patients with rhinitis. The Allergic Rhinitis and its Impact on Asthma (ARIA)-pharmacy ICP includes a diagnostic questionnaire specifically focusing attention on key symptoms and markers of the disease, a systematic Diagnosis Guide (including differential diagnoses), and a simple flowchart with proposed treatment for rhinitis and asthma multimorbidity. Key prompts for referral within the ICP are included. The use of technology is critical to enhance the management of allergic rhinitis. However, the ARIA-pharmacy ICP should be adapted to local healthcare environments/situations as regional (national) differences exist in pharmacy care.

Mystery shopping and coaching as a form of audit and feedback to improve community pharmacy management of non-prescription medicine requests: an intervention study

OBJECTIVES

To determine whether repeated mystery shopping visits with feedback improve pharmacy performance over nine visits and to determine what factors predict an appropriate outcome.

DESIGN

Prospective, parallel, repeated intervention, repeated measures mystery shopping (pseudopatient) design.

SETTING

Thirty-six community pharmacies in metropolitan Sydney, Australia in March-October 2015.

PARTICIPANTS

Sixty-one University of Sydney pharmacy undergraduates acted as mystery shoppers. Students enrolled in their third year of Bachelor of Pharmacy in 2015 were eligible to participate. Any community pharmacy in the Sydney metropolitan region was eligible to take part and was selected through convenience sampling.

INTERVENTION

Repeated mystery shopping with immediate feedback and coaching.

OUTCOME MEASURES

Outcome for each given scenario (appropriate or not) and questioning scores for each interaction.

RESULTS

Five hundred and twenty-one visits were analysed, of which 54% resulted in an appropriate outcome. Questioning scores and the proportion of interactions resulting in an appropriate outcome significantly improved over time (P<0.001). Involvement of pharmacists, visit number, increased questioning score and the prescribed scenario were predictors of an appropriate outcome (P=0.008, P=0.022, P<0.001 and P<0.001, respectively). Interactions involving a pharmacist had greater scores than those without (P<0.001).

CONCLUSIONS

Repeated mystery shopping visits with feedback were associated with improved pharmacy performance over time. Future work should focus on the role of non-pharmacist staff and design interventions accordingly.