Counselling quality in community pharmacies: implementation of the pseudo customer methodology in Germany

Objectives: To investigate a new method for evaluating counselling performance of staff in community pharmacies and to assess the quality of patient counselling. Method: Trained pseudo customers, instructed to play their role according to two different self-medication scenarios, visited voluntarily participating community pharmacies in Berlin. After documenting the counselling process, immediately after each visit, outside the pharmacy on an assessment form, the pseudo customer re-entered the pharmacy and gave detailed performance feedback to the counsellor and the pharmacist in charge in order to provide support for improving counselling skills and practice behaviour, when appropriate. This was followed with a written summary of the general performance of all participating pharmacies and additional individual feedback and suggestions for improvement. Educational needs were identified for subsequent performance-based educational strategies such as group-workshops, team-training and on-site team-coaching. Results: Forty-nine community pharmacies in Berlin volunteered to participate in this pilot study. Ninety-eight per cent of the participating pharmacies offered advice. However, in 36% of the cases, advice was only given on request. The different types of scenarios – presentation of a symptom or request for a specific product – made a great difference to the spontaneity of questions and advice. At least one question to check on accuracy of self-diagnosis was asked in 95% of the cases of symptom presentation but in only 47% of the cases of specific product request. Information on appropriate self-medication was provided on at least one item in 74% of pseudo customer visits, but most of the time the information was not sufficient. Communication skills (nonverbal elements, comprehensibility etc.) were very good or good in 54% of the visits. Potential for improvement was mainly in relation to the use of open-ended questions to gain more information and on counselling about appropriate self-medication. Direct feedback was given in 96% of the pharmacies (one person refused to accept feedback and one feedback had to be postponed because of time shortage). All of the participants regarded counselling as an important subject in pharmacy practice. Conclusion: The pseudo customer method was successfully used in this study of German community pharmacies. It was shown that pseudo customer visits and performance feedback following the counselling process, were feasible in daily practice and well accepted by the participants. A training program, focussing on areas in most need of improvement, has been developed. The promising results have led to the Federal Chamber of Pharmacists in Germany adopting this method as part of a continuous quality improvement program in community pharmacies.     

Misconceptions of older adults with hypertension concerning OTC medications and alcohol

Knowledge and self-efficacy concerning interactions of antihypertensives with over-the-counter (OTC) analgesics and alcohol were assessed in 51 adults aged 60 and older taking antihypertensives and attending a blood pressure clinic. The subjects had low self-efficacy about how to prevent interactions of antihypertensives with OTC analgesics and alcohol. Inspection of knowledge item responses revealed eight general misconceptions about OTC medications. These data guide educating those with hypertension about potential drug interactions arising from self-medication.     

Over-the-counter oral nonsteroidal anti-inflammatory drugs: A pharmacoepidemiologic study in southern Italy

The Pharmacoepidemiologic Service of the Second University of Naples analyzed the use and tolerability of over-the-counter (OTC) oral nonsteroidal antiinflammatory drugs (NSAIDs) purchased in Campania, a region of southern Italy. Forty private pharmacies uniformly distributed throughout the region were recruited. The study was conducted by means of a questionnaire completed by purchasers and lasted from December 1, 1999 to March 31, 2000; 2053 questionnaires were collected. The age of respondents averaged 45.3 ± 3.49 years (range, 17–85 years). The NSAIDs analyzed were acetylsalicylic acid, paracetamol, ibuprofen, ketoprofen, diclofenac, and piroxicam. Adverse effects, mainly gastrointestinal symptoms, were reported by 5.5% of the users and occurred primarily with diclofenac, piroxicam, ibuprofen, and ketoprofen. Because the use and availability of OTC NSAIDs are increasing, further studies of the tolerability of this important drug class are warranted.     

The potential for adverse drug reactions in elderly patients

This study examined inappropriately prescribed drugs, inappropriate dosages of drugs, inappropriate combinations of drugs, and numbers of drugs and their potential for causing adverse drug reactions (ADRs) in the elderly. The study also looked at whether the number of diagnoses made a difference in the drugs' potential to cause ADRs. A retrospective audit was made of 146 patients diagnosed with congestive heart failure (CHF) who were admitted to a suburban community agency. Significant correlations were found between the number of medications prescribed and the number of inappropriate medications, the number of medications prescribed and the number of inappropriate dosages of medications, and the number of medications prescribed and the number of potential drug interactions. Multiple diagnoses did not make a difference.