1
|
van der Sande M, Ingelbeen B, Meudec M, van Kleef E, Campbell L, Wouters E, Marien J, van Vredendaal R, Leirs H, Valia D, Yougbare S, Kouanda Juste S, Welgo A, Tinto H, Mpanzu D, Mbangi B, Khoso Muaka CA, Kiabanza O, Melanda A, Makuaya R, Ndomba D, Diagne PM, Heyerdahl L, Giles-Vernick T, Van Puyvelde S, Cooper B. Evaluating the effect of a behavioural intervention bundle on antibiotic use, quality of care, and household transmission of resistant Enterobacteriaceae in intervention versus control clusters in rural Burkina Faso and DR Congo (CABU-EICO). Trials 2024; 25:91. [PMID: 38281023 PMCID: PMC10821568 DOI: 10.1186/s13063-023-07856-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 12/06/2023] [Indexed: 01/29/2024] Open
Abstract
BACKGROUND Antimicrobial resistance (AMR) is a rising threat in low-resource settings, largely driven by transmission in the community, outside health facilities. Inappropriate antibiotic use is one of the main modifiable drivers of AMR. Its risk is especially high in poor resource settings, with limited diagnostic and surveillance capacities, and many informal medicine vendors determining community use. We hypothesise that to optimise community antibiotic use, especially Watch antibiotics (recommended only as first-choice for more severe clinical presentations or for causative pathogens likely to be resistant to Access antibiotics), both the supply side (medicine vendors) and the demand side (communities) should be pro-actively involved in any intervention. METHODS In two existing demographic health surveillance sites (HDSS) in Burkina Faso and in the Democratic Republic of Congo, behavioural intervention bundles were co-created in a participatory approach, aiming to rationalise (Watch) antibiotic use and improve hygiene and sanitation practices. Bundles consisted of interactive interventions, including theatre, posters, discussions, etc. To evaluate impact, 11 of 22 clusters (a HDSS community with at least one (in)formal medicine vendor) were randomly assigned to this intervention, which will run over a year. The effect of the intervention will be evaluated by comparing outcomes before and after in intervention and control villages from a) exit interviews of clients from vendors, b) mystery patients presenting to vendors with a set of predefined symptoms, c) household interviews to assess behavioural changes related to antibiotic use, health literacy and water-sanitation-hygiene indicators. Long-term impact on AMR will be estimated by modelling changes in resistant Enterobacteriaceae carriage from repeated household surveys before, during and after the intervention in both arms. DISCUSSION Most existing interventions aimed at improving antibiotic use focus on health care use, but in resource-limited settings, community use is highly prevalent. Previous studies targeting only providers failed to show an effect on antibiotic use. Evaluation will be done with before-after epidemiological measurements of actual prescriptions and use. If effective in reducing (Watch) antibiotic use, this would be an empowering methodology for communities, which has significant promise for long-term impact. TRIAL REGISTRATION ClinicalTrials.gov NCT05378880 . 13 May 2022.
Collapse
|
2
|
Alastalo N, Siitonen P, Jyrkkä J, Hämeen-Anttila K. The quality of non-prescription medicine counselling in Finnish pharmacies - a simulated patient study. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 11:100304. [PMID: 37521017 PMCID: PMC10371815 DOI: 10.1016/j.rcsop.2023.100304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 08/01/2023] Open
Abstract
Background Medication counselling provided by pharmacists is important for ensuring the safe use of medicines. Objective To assess the quality of non-prescription medicines counselling in Finnish pharmacies. Methods Three scenarios using simulated patient methodology were conducted: the patient requesting a specific brand name Burana® (ibuprofen, OTC medicine), Pronaxen® (naproxen, behind-the-counter (BTC) medicine) and a nasal spray. The visits were conducted in 146 pharmacies by trained simulated patients. Each pharmacy was visited twice. The quality of counselling was defined as poor (1-2 points), moderate (3-4 points), or high (5-6 points) based on developed scenario-based scoring criteria. Results The total number of conducted visits was 292, of which only 29 received high quality counselling. The quality was high in 20% of the cases for Pronaxen® and in 7% of the cases for Nasal spray scenarios. In the Burana® scenario, counselling quality was high only in 2% of the cases. Patients who requested a nasal spray were often asked questions about their symptoms (93%). In the Pronaxen®-scenario, the most frequently asked questions were related to contraindications and drug interactions (56%). The most often given instructions varied between the scenarios, being follow-up in the Burana® and Nasal spray scenarios (17% and 70%, respectively) and how to use the medicine in the Pronaxen®-scenario (63%). Conclusions Non-prescription medicine counselling is rarely performed with high quality. However, the quality of counselling depends on the medication in question. There is room to improve medication counselling and the assessment of the necessity and suitability of treatment, especially when a patient requests an OTC pain medicine by its brand name.
Collapse
Affiliation(s)
- Niina Alastalo
- School of Pharmacy, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland
| | - Piia Siitonen
- School of Pharmacy, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland
| | - Johanna Jyrkkä
- Finnish Medicines Agency Fimea, PO Box 55, 00034 Fimea, Kuopio, Finland
| | - Katri Hämeen-Anttila
- School of Pharmacy, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland
| |
Collapse
|
3
|
Ng R, O'Reilly CL, Collins JC, Roennfeldt H, McMillan SS, Wheeler AJ, El-Den S. Mental Health First Aid crisis role-plays between pharmacists and simulated patients with lived experience: a thematic analysis of debrief. Soc Psychiatry Psychiatr Epidemiol 2023; 58:1365-1373. [PMID: 36928545 PMCID: PMC10423112 DOI: 10.1007/s00127-023-02443-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 02/27/2023] [Indexed: 03/18/2023]
Abstract
PURPOSE Healthcare professionals, including pharmacists, can recognise and assist people experiencing mental health crises. Despite this, little is known about how pharmacists assist and engage with people presenting with signs and symptoms of mental health crises. This study aimed to (i) examine pharmacists' mental health crisis assessment language during simulated patient role-plays (SPRPs) and (ii) explore participants' experiences of participating in SPRPs of Mental Health First Aid (MHFA) scenarios. METHODS Fifty-nine MHFA-trained pharmacy staff participated in audio-recorded SPRPs of three crisis scenarios enacted by a mental health consumer educator (MHCE). Post-SPRP, pharmacy staff members (including role-playing and observing participants), engaged in reflective debrief discussions with the facilitator and MHCEs. Debrief discussions were transcribed verbatim and analysed using inductive thematic analysis and suicide assessment language was explored. RESULTS The majority of role-playing pharmacists asked about suicidal ideation using appropriate, direct language (n = 8). Qualitative analyses of debrief discussions yielded four themes: (i) Relationship with the consumer, (ii) Verbal and non-verbal communication, (iii) Challenges with crisis assessment, which included difficulties associated with initiating conversations about suicide and mania, and (iv) Reflective learning. CONCLUSION While pharmacists demonstrated the appropriate suicide assessment language post-MHFA training, pharmacists felt uncomfortable initiating conversations around suicide and lacked confidence during crisis assessments. SPRPs provided pharmacists with opportunities to reflect on and practice MHFA skills in a safe learning environment. Future research exploring how MHFA training and SPRPs impact pharmacists' ability to provide MHFA in real-world settings is warranted.
Collapse
Affiliation(s)
- Ricki Ng
- Faculty of Medicine and Health, Pharmacy and Bank Building A15, The University of Sydney School of Pharmacy, The University of Sydney, Science Road, Camperdown, NSW, 2006, Australia.
| | - Claire L O'Reilly
- Faculty of Medicine and Health, Pharmacy and Bank Building A15, The University of Sydney School of Pharmacy, The University of Sydney, Science Road, Camperdown, NSW, 2006, Australia
| | - Jack C Collins
- Faculty of Medicine and Health, Pharmacy and Bank Building A15, The University of Sydney School of Pharmacy, The University of Sydney, Science Road, Camperdown, NSW, 2006, Australia
| | - Helena Roennfeldt
- Menzies Health Institute Queensland, Nathan Campus, Griffith University, Nathan, Australia
- Centre for Mental Health, Griffith University, Brisbane, Australia
| | - Sara S McMillan
- Menzies Health Institute Queensland, Nathan Campus, Griffith University, Nathan, Australia
- School of Pharmacy and Medical Sciences, Griffith Health, Griffith University, Gold Coast, Australia
- Centre for Mental Health, Griffith University, Brisbane, Australia
| | - Amanda J Wheeler
- Menzies Health Institute Queensland, Nathan Campus, Griffith University, Nathan, Australia
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Centre for Mental Health, Griffith University, Brisbane, Australia
| | - Sarira El-Den
- Faculty of Medicine and Health, Pharmacy and Bank Building A15, The University of Sydney School of Pharmacy, The University of Sydney, Science Road, Camperdown, NSW, 2006, Australia
| |
Collapse
|
4
|
Zhou W, Wang J, Chen Q, Huang Z, Zhou N, Hu M. Assessment of the operation status of electronic prescription at community pharmacies in Chengdu, China: a simulated patient study. BMC Health Serv Res 2023; 23:920. [PMID: 37644463 PMCID: PMC10466720 DOI: 10.1186/s12913-023-09742-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 06/22/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Information and technologies relevant to eHealth have developed rapidly over the past two decades. Based on this, China piloted "Internet + " pattern and some regions piloted electronic prescription services to explore telepharmacy services. OBJECTIVE To describe the processes and assess the operation status of electronic prescription services mode for community pharmacies in China. METHODS The simulated patient methodology was used to conduct a cross-sectional study in 317 community pharmacies from six districts in Chengdu, China in 2019. Simulated patients expressed three levels of service demands based on scenario about acute upper respiratory tract infections to evaluate the recommendation strength of electronic prescription services and telepharmacy service in community pharmacies. The descriptive statistics was completed to obtain the characteristics of the visit process, student t-test and χ2 test (P < 0.05 was considered statistically significant) were used for inferential statistical analysis to determine differences in characteristics and degree of recommendation between pharmacies. RESULTS Three Hundred Seventeen record sheets were effectively collected. The third-party platform was recommended in 195 (61.5%) interactions. The main reason for not recommending is non-prescription dispensing of prescription drugs (27.1%). 90.3% interactions waited less than 1 min, the counseling duration was less than 5 min in all interactions, and most community pharmacies had good network conditions (81.5%). 97.4% remote physicians offered professional counseling, only 22.1% of the pharmacists provided medication advice. CONCLUSIONS The electronic prescription services mode for community pharmacies in Chengdu provides a convenient drug purchase process but remains some problems. For example, prescribing drugs without a prescription and services provided by pharmacists was poor, etc. The relevant supporting policies should be improved in future development process.
Collapse
Affiliation(s)
- Wenxin Zhou
- School of Pharmacy, Sichuan University, No. 17, 3Rd Section, Renmin South Road, 610041, Chengdu, P.R. China
| | - Jing Wang
- School of Pharmacy, Sichuan University, No. 17, 3Rd Section, Renmin South Road, 610041, Chengdu, P.R. China
- Clinical Research Institute, the Affiliated Hospital of Southwest Medical University, 646000, Luzhou, P.R. China
| | - Qinmin Chen
- School of Pharmacy, Sichuan University, No. 17, 3Rd Section, Renmin South Road, 610041, Chengdu, P.R. China
| | - Zhen Huang
- Market Supervision Administration of Chengdu Municipality, 610041, Chengdu, P.R. China
| | - Naitong Zhou
- School of Pharmacy, Sichuan University, No. 17, 3Rd Section, Renmin South Road, 610041, Chengdu, P.R. China.
| | - Ming Hu
- School of Pharmacy, Sichuan University, No. 17, 3Rd Section, Renmin South Road, 610041, Chengdu, P.R. China.
| |
Collapse
|
5
|
Lungfiel G, Mandlmeier F, Kunow C, Langer B. Oral emergency contraception practices of community pharmacies: a mystery caller study in the capital of Germany, Berlin. J Pharm Policy Pract 2023; 16:68. [PMID: 37237301 DOI: 10.1186/s40545-023-00565-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 04/25/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND In Germany, oral emergency contraception (EC) with the active ingredients levonorgestrel (LNG) and ulipristal acetate (UPA) is available as over-the-counter (OTC) medicine only from community pharmacies (CPs). Because of the window of effect, which is limited to only a few days, CPs have a great responsibility to provide rapid and unimpeded access, while also ensuring "adequate" counseling. The aim was-for the first time in Europe and thus also in Germany for the methodology used in this study-to investigate immediate availability, pricing, and aspects of counseling. METHODS Covert mystery calls were conducted in a random sample of CPs stratified by districts in the German capital Berlin. Each of the 263 CPs included was called once at random by one of two trained female student mystery callers. They simulated a product-based scenario for the UPA original ellaOne®, citing a contraceptive failure one day ago as the reason. RESULTS Of 257 successfully called CPs, UPA preparations were immediately available in 98.4% (253/257) and LNG preparations in 86.8% (184/212) of CPs. Prices for UPA preparations varied from €15.95 to €42.95 (∆ 169%; median €35.00 [interquartile range (IQR) €5.91]) and for LNG preparations from €10.60 to €32.49 (Δ 207%; median €22.00 [IQR €5.76]). Information about the correct different window of effect of UPA and LNG preparations was provided in 69.8% (127/182) of CPs. UPA preparations were recommended in 63.1% (111/176) and LNG preparations in 17.2% (30/174) of CPs. Information was provided on how to take them as soon as possible in 30.8% (44/143) of CPs and on how to use them after vomiting in 46.0% (64/139). CONCLUSIONS Berlin CPs support access through high immediate availability, especially to UPA preparations. However, access is hampered by high absolute price ranges of both UPA and LNG preparations, which could ideally be minimized by a comparison app. It is positive that CPs promote the benefits of UPA preparations by recommending them noticeably more often than LNG preparations. However, there are deficiencies in giving advice, so there is a need to raise awareness among pharmacy staff to ensure "adequate" counseling in advance over the phone.
Collapse
Affiliation(s)
- Gwenda Lungfiel
- Department of Health, Nursing, Management, University of Applied Sciences Neubrandenburg, Neubrandenburg, Germany
| | - Franca Mandlmeier
- Department of Health, Nursing, Management, University of Applied Sciences Neubrandenburg, Neubrandenburg, Germany
| | - Christian Kunow
- Department of Health, Nursing, Management, University of Applied Sciences Neubrandenburg, Neubrandenburg, Germany
| | - Bernhard Langer
- Department of Health, Nursing, Management, University of Applied Sciences Neubrandenburg, Neubrandenburg, Germany.
| |
Collapse
|
6
|
Kunow C, Langer B. Using the Simulated Patient Methodology in the Form of Mystery Calls in Community Pharmacy Practice Research: A Scoping Review Protocol. PHARMACY 2023; 11:pharmacy11020047. [PMID: 36961025 PMCID: PMC10037651 DOI: 10.3390/pharmacy11020047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 02/26/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
Community pharmacies (CPs) play a major role in health care delivery. The simulated patient methodology (SPM), which is considered the "gold standard", is recommended for studying CP practice. SPM can be applied in different forms, which include visits and also calls ("mystery calls"). So far, only the role of visits in the investigation of CP practice is known. As the first study worldwide, a systematic map of such reports will be provided, which applies calls in the context of the SPM for the study of CP practice. Reports with the pharmacy staff as the population under study should be included. Reports should be included that conduct an investigation using the SPM in the form of calls to simulate patients and other customers. Reports should be included that examine CP practice as defined by the International Pharmaceutical Federation and the World Health Organization (FIP/WHO). The scoping review methodology will be applied using the associated guidelines from Joanna Briggs Institute (JBI) and PRISMA extension for Scoping Review (PRISMA-ScR). The search will be for both published and unpublished original research in English with transparent information on SPM until the end of 2022. The plan is to search Embase, MEDLINE via PubMed, and Web of Science. Directly afterward, the respective literature collection of the reviewers and the reference lists of suitable international reviews will be searched. This will be followed by a forward and backward snowballing in Google Scholar. For the inclusion of reports, a selection process and for the data extraction a data charting process with the help of variables derived from related reviews and from two SPM-form spanning international guidelines will be performed. The data extracted from the included reports should be synthesized and presented in MS Excel tabular form using the previously determined variables.
Collapse
Affiliation(s)
- Christian Kunow
- Department of Health, Nursing, Management, University of Applied Sciences Neubrandenburg, Brodaer Straße 2, 17033 Neubrandenburg, Germany
| | - Bernhard Langer
- Department of Health, Nursing, Management, University of Applied Sciences Neubrandenburg, Brodaer Straße 2, 17033 Neubrandenburg, Germany
| |
Collapse
|
7
|
Mauricio C, Andrea SO, Daniel SH, Pedro A. Effectiveness of a continuing education program of drugs with fiscalized substance to improve pharmacy staff competencies: A multicenter, cluster-randomized controlled trial. Pharm Pract (Granada) 2022; 20:2632. [PMID: 36733513 PMCID: PMC9851815 DOI: 10.18549/pharmpract.2022.3.2632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 08/06/2022] [Indexed: 02/05/2023] Open
Abstract
Background Drugs with fiscalized substances without a correct prescription may lead to undesirable side effects. Pharmacy staff needs to improve their competencies (knowledge, skills, and attitudes) to contribute to providing ambulatory pharmacy services and minimizing medication errors. Continuing education programs (CEP) could favor access to relevant and quality information on health promotion, disease prevention, and the rational use of drugs. Objective To evaluate the effectiveness of a continuing education program to improve pharmacy staff competencies to enhance the use of drugs with fiscalized substances. Methods A multicenter, prospective, parallel-group, cluster-randomized, controlled clinical trial was conducted in drugstores and pharmacies in Colombia (ambulatory retail establishments). The intervention group (IG) received a CEP: a web-based social networking site, a virtual course, a dispensing information system, and face-to-face training. The control group (CG) received general written material on the correct use of drugs. We measured pharmacy staff's skills, attitudes, and knowledge self-reported scores, and the simulated patient technique was used to assess the participant skills and attitudes in real practice. We used a questionnaire designed for this study, which was evaluated by a group of experts and piloted and showed a Cronbach's alpha of 0.96. Results Three hundred five drugstores and pharmacies were enrolled in two groups: IG (n = 153) and CG (n = 152). Out of the 750 potential participants, 88% (n=659) agreed to participate. The pharmacy staff's skills, attitudes, and knowledge self-reported scores post-intervention were higher than baseline in both groups; however, the IG had statistically significantly higher scores than the CG. Post-intervention, the self-efficacy skills and attitudes in the IG improved by 88% (22 of 25) and in six of the seven assessed knowledge components (p<0.001). However, the dispensing criteria evaluated with simulated patient methodology showed no statistically significant differences between groups in the pharmacy staff's skills and attitudes in real practice. Conclusions Providing a continuing education program using different educational strategies improved the pharmacy staff's competencies (assessed knowledge and self-reported skills and attitudes) to enhance the use of drugs with fiscalized substances. However, there were no improvements in skills and attitudes in real practice. These findings could show that pharmacy staff needs additional and continuous training/sustainability.
Collapse
Affiliation(s)
- Ceballos Mauricio
- Research Group on Pharmaceutical Promotion and Prevention, Research Group on Pharmacy Regency Technology. University of Antioquia, Medellin, Colombia.
| | - Salazar-Ospina Andrea
- Research Group on Pharmaceutical Promotion and Prevention, Research Group on Pharmacy Regency Technology. University of Antioquia, Medellin, Colombia.
| | | | - Amariles Pedro
- Research Group on Pharmaceutical Promotion and Prevention. University of Antioquia, Medellin, Colombia; Pharmaceutical Care Research Group, Faculty of Pharmacy, University of Granada, Granada, Spain.
| |
Collapse
|
8
|
Boura F, Al-Tabakha M, Hassan N, Darwich M. Critical appraisal of simulated patient methodology to assess the practice of community pharmacist in the Middle East and North Africa region: A systematic review. Pharm Pract (Granada) 2022; 20:2701. [PMID: 36733522 PMCID: PMC9851829 DOI: 10.18549/pharmpract.2022.3.2701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 08/05/2022] [Indexed: 02/05/2023] Open
Abstract
Background The use of simulated patient (SP) methodology in pharmacy practice settings has increased recently. However, its applications can vary significantly within a region, hence affecting the quality of the SP methodology. Objective The purpose of this systematic review is to critically assess the use of the SP methodology for assessing the practice of community pharmacists (CP) in the Middle East and North Africa (MENA) region. Methods A comprehensive literature search was conducted using EMBASE, MEDLINE, ProQuest, and SCOPUS to identify articles published from 2011 to 2022. The selection of relevant studies for inclusion in the systematic review was based on the pre-determined inclusion criteria. The Mixed Method Appraisal Tool (MMAT) was used to assess the methodological quality of the included studies. Results Electronic search yielded 478 publications. A total of 45 studies were reviewed. The studies were conducted in 12 countries of the MENA region. The sample size between the reviewed articles ranged from 20 to 1000 (median= 129). A greater number of the included studies measured the adequacy of skill (pre-dispensing and/or post-dispensing) 38 (84.4%). The vast majority of the studies reported unsatisfactory results regarding the competencies of CP. The number of the SP ranged from 1 to 37 (median= 2). Most of the studies recruited only one SP per pharmacy 35 (77.8%). The most common data collection method was written data collection form 42 (93.3%). Few studies only had a detection system for SP visits 11 (24.4%), and only six studies incorporated performance feedback (13.3%). More than two-thirds of the studies provided a training session for SP 37 (82.2%). There was variation in the symptoms and drugs used in the SP scenarios in the studies. Conclusion Although the results demonstrate the growth in the use of the SP method in MENA region countries, studies showed high variability in the level of reporting the study methodology. Consequently, we argue the need for standardized reporting of these studies.
Collapse
Affiliation(s)
- Fatima Boura
- BSc, MSc. Department of Clinical Sciences, College of Pharmacy and Health Science, Ajman University, Ajman, United Arab Emirates.
| | - Moawia Al-Tabakha
- BPharm, PhD. Department of Pharmaceutical Sciences, College of Pharmacy and Health Science, Ajman University, Ajman, United Arab Emirates.
| | - Nageeb Hassan
- MBBS., MSc, PhD. Department of Clinical Sciences, College of Pharmacy and Health Science, Ajman University, Ajman, United Arab Emirates.
| | - Mohamad Darwich
- MD, MRCPH. Department of pediatrics. Medcare Hospital, Sharjah, United Arab Emirates.
| |
Collapse
|
9
|
Ayele AA, Islam MS, Cosh S, East L. Community pharmacy professionals' practice in responding to minor symptoms experienced by pregnant women in Ethiopia: results from sequential mixed methods. J Pharm Policy Pract 2022; 15:29. [PMID: 35387691 PMCID: PMC8988357 DOI: 10.1186/s40545-022-00427-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/29/2022] [Indexed: 12/02/2022] Open
Abstract
Background In countries with limited access to healthcare services, community pharmacists’ management of minor symptoms experienced by pregnant women could be beneficial in terms of alleviating the burden of other health professionals and cost of services. However, evidence is limited regarding the practice of community pharmacy professionals in responding to minor pregnancy-related symptoms more generally, particularly in Ethiopia. Objective The aim of this study was to evaluate actual and self-reported practice of community pharmacists in the management of minor symptoms during pregnancy in Ethiopia. Methods A sequential mixed method study using self-reported survey from 238 community pharmacists followed by 66 simulated client visits was conducted from March to July 2020 in six towns of the Amhara regional state in Ethiopia. Independent samples t-test and one-way Analysis of Variance was used to test the mean difference of practice score among subgroups of study participants. Results The self-reported survey showed that most community pharmacist would ‘always’ gather most symptom-related information particularly about ‘duration of symptoms,’ ‘frequency of symptoms,’ and ‘gestational age’ and provide medication-related information on ‘how to use the medication’ and ‘duration of use.’ The highest mean practice scores were observed in relation to information gathering about ‘gestational age’ and information provision on ‘how to use the medication.’ In contrast, the lowest mean practice scores were observed in relation to information gathering about ‘weight of the woman’ and information provision on ‘dosage form.’ However, the actual practice, as revealed by the simulated client visits, demonstrated that most community pharmacists would rarely gather symptom-related information nor provide medication-related information. In addition, dispensing of non-prescribed medications to pregnant women was also common. The extent of self-reported practice differed among subgroups of study participants. Conclusions This study highlights extent of practice of community pharmacy professionals during the management of minor symptoms in pregnancy in Ethiopia. Discrepancies of results between self-reported and actual practices of community pharmacy professionals were observed. The inadequate actual practice of symptom-related information gathering and medication-related information provisions needs considerations of implementing interventions to minimize potential harms. Supplementary Information The online version contains supplementary material available at 10.1186/s40545-022-00427-x.
Collapse
Affiliation(s)
- Asnakew Achaw Ayele
- School of Health, Faculty of Medicine and Health, University of New England, Armidale, 2351, Australia. .,Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia.
| | - Md Shahidul Islam
- School of Health, Faculty of Medicine and Health, University of New England, Armidale, 2351, Australia
| | - Suzanne Cosh
- School of Psychology, Faculty of Medicine and Health, University of New England, Armidale, 2351, Australia
| | - Leah East
- School of Health, Faculty of Medicine and Health, University of New England, Armidale, 2351, Australia.,Hunter New England Health, Armidale, 2350, Australia
| |
Collapse
|
10
|
The Quality of Counseling for Headache OTC Medications in German Community Pharmacies Using a Simulated Patient Approach: Are There Differences between Self-Purchase and Purchase for a Third Party? ScientificWorldJournal 2022; 2022:5851117. [PMID: 35370483 PMCID: PMC8967581 DOI: 10.1155/2022/5851117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/09/2022] [Accepted: 02/12/2022] [Indexed: 11/24/2022] Open
Abstract
Background In Germany—as worldwide—headache is one of the most frequent causes of self-medication. The dispensing of over-the-counter (OTC) medications may only be carried out by community pharmacies (CPs). In doing so, CPs have to ensure “adequate” counseling, for both self-purchase and purchase for a third party, which also occurs in everyday pharmacy practice. The aim of this study was to evaluate the quality of counseling for headache OTC medications in German CPs and, as the first study worldwide, to analyze whether and to what extent there are differences in counseling between self-purchase and purchase for a third party. Methods A cross-sectional study was carried out using the covert simulated patient methodology (SPM) in all 42 CPs in the German big city Potsdam. With the help of 8 trained simulated patients (SPs), each CP was visited four times by a different SP. The SPs simulated in each CP two scenarios two times with the demand for an OTC medication against headache, which differed only in whether the demand was for themselves or for their boyfriend/girlfriend. Results All 168 planned pharmacy visits (84 visits per scenario) were successfully carried out. Overall, the median counseling score was 3.0 out of 9 points (interquartile range [IQR 2.0]). There were no significant differences between the two scenarios (Wilcoxon signed-rank test; p=0.495, r = 0.053). In a multivariate binary logistic regression analysis, the counseling level and the different scenarios were not significantly associated (adjusted odds ratio [AOR] = 1.635, 95% CI = 0.673–3.972, p=0.278). Conclusions Due to the partly considerable deficits in counseling of German CPs, policy-makers and the regional chambers of pharmacists are called upon to take appropriate measures to improve the quality of counseling. It is positive that no differences in counseling between self-purchase and purchase for a third party were found, but further verifying studies with a modified methodology are recommended.
Collapse
|
11
|
ElGeed H, El Hajj MS, Ali R, Awaisu A. The utilization of simulated patients for teaching and learning in the pharmacy curriculum: exploring pharmacy students' and recent alumni's perceptions using mixed-methods approach. BMC MEDICAL EDUCATION 2021; 21:562. [PMID: 34742275 PMCID: PMC8571846 DOI: 10.1186/s12909-021-02977-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 10/08/2021] [Indexed: 05/31/2023]
Abstract
BACKGROUND The use of simulated patients (SPs) is considered a significant resource for teaching and assessing clinical and communication skills in health professional education. We conducted this study to explore pharmacy students' perspective towards the utilization of SPs in Qatar and to identify areas that require improvement. METHODS An explanatory sequential mixed-methods design was used among students and recent graduates of the College of Pharmacy at Qatar University (QU-CPH). First, their perspectives toward the current utilization of SPs at QU-CPH was explored using a quantitative cross-sectional study design. Following this, we conducted six focus group discussions based on the analysis of the questionnaire results. The findings of the two phases were interpreted through integration of the quantitative and qualitative phases. RESULTS The majority of the participants (> 90%) reported that interactions with SPs are important in building good communication and counseling skills during professional skills course activities. Similarly, most of the respondents (80%) indicated that interactions with SPs prepared them to apply the clinical skills gained during professional skills and patient assessment sessions in real-life. In addition, they reported that interactions with SPs during competency-based assessments were good experiences. The participants disagreed with the notion that interaction with SPs of opposite gender was uncomfortable for them. Themes identified from the focus groups include: interactions with trained SPs compared to faculty SPs, standardization and consistency of SPs' roles, communication and language barriers, simulations of real-life case scenarios, SPs' competence and preparedness, psychological impact associated with interaction with SPs, proposed strategies for improving the SP program. Identified areas for improvement include the need for strengthening the SP training and orientation program as well as the SP selection criteria. CONCLUSION This study showed a positive impact of the utilization of SPs in this pharmacy curriculum as perceived by students and alumni. However, the SP program needs to be optimized in terms of the training and orientation of SPs.
Collapse
Affiliation(s)
- Hager ElGeed
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, P.O. Box 2713, Doha, Qatar
| | - Maguy Saffouh El Hajj
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, P.O. Box 2713, Doha, Qatar
| | - Raja Ali
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, P.O. Box 2713, Doha, Qatar
| | - Ahmed Awaisu
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, P.O. Box 2713, Doha, Qatar.
| |
Collapse
|
12
|
A Nationwide Mystery Caller Evaluation of Oral Emergency Contraception Practices from German Community Pharmacies: An Observational Study Protocol. Healthcare (Basel) 2021; 9:healthcare9080945. [PMID: 34442082 PMCID: PMC8391881 DOI: 10.3390/healthcare9080945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/04/2021] [Accepted: 07/22/2021] [Indexed: 11/16/2022] Open
Abstract
To prevent unwanted pregnancies, oral emergency contraception (EC) with the active ingredients levonorgestrel (LNG) and ulipristal acetate (UPA) is recommended by the guidelines of the German Federal Chamber of Pharmacists (BAK). In this respect, community pharmacies (CPs) in Germany have a major responsibility for information gathering, selecting the appropriate medicine, availability and pricing, among other things. Therefore, it would be appropriate to conduct a study with the aim of investigating information gathering, a possible recommendation as well as availability and pricing for oral EC in German CPs. A representative nationwide observational study based on the simulated patient methodology (SPM) in the form of covert mystery calls will be conducted in a random sample of German CPs stratified according to the 16 federal states. Each selected CP will be randomly called once successfully by one of six both female and male trained mystery callers (MCs). The MCs will simulate a product-based scenario using the request for oral EC. For quality assurance of the data collection, a second observer accompanying the MC is planned. After all mystery calls have been made, each CP will receive written, pharmacy-specific performance feedback. The only national SPM study on oral EC to date has identified deficits in the provision of self-medication consultations with the help of visits in the CPs studied. International studies suggest that UPA in particular is not always available. Significant price differences could be found analogous to another German study for a different indication.
Collapse
|
13
|
Ceballos M, Llano Y, Salazar-Ospina A, Madrigal-Cadavid J, Pino-Marín D, Amariles P. Skills and practices of pharmacy staff for dispensing of drugs with fiscalized substances in drugstores and pharmacies. Rev Saude Publica 2021; 55:44. [PMID: 34231824 PMCID: PMC8244815 DOI: 10.11606/s1518-8787.2021055003103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 11/11/2020] [Indexed: 11/13/2022] Open
Abstract
OBJETIVE To evaluate the skills and practices of pharmacy staff during the dispensing of tramadol (drug with fiscalized substance) in drugstores and pharmacies in Medellin, Colombia. METHODS A cross-sectional study was performed. The simulated patient technique was used. The main outcomes included the information provided on the dispensed drug (tramadol), the use of tools to provide information, and the information provided on drug precautions and use recommendations. RESULTS We visited 305 drugstores and pharmacies. The average dispensing time was 2.3 min (SD 1.1 min). In nine drugstores and pharmacies (3.0%), tramadol was not dispensed because it was not in stock. In 17 drugstores and pharmacies (5.7%), the simulated patients were actively informed by the dispensing pharmacy staff; of these, 16 provided oral information and one provided oral and written information. Eight patients (2.7%) received information regarding tramadol use. However, 99% of patients were not informed about tramadol side effects such as dependence, sedation, or hypnosis, and none of the simulated female patients were informed on the precautions related to tramadol use during pregnancy or lactation. CONCLUSIONS Communication skills and appropriate practices of pharmacy staff are critical to patient self-care. However, this study shows their difficulty in counseling about precautions and use recommendations of drugs with fiscalized substances. These outcomes could inform future studies focusing on the rational use of these drugs in drugstores and pharmacies. It is necessary to improve the pharmacy staff competencies through continuing education programs, to facilitate access to information and training.
Collapse
Affiliation(s)
- Mauricio Ceballos
- Universidad de Antioquia. Facultad de Ciencias Farmacéuticas y Alimentarias. Departamento de Farmacia. Medellín, Antioquia, Colombia
| | - Yaqueline Llano
- Universidad de Antioquia. Facultad de Ciencias Farmacéuticas y Alimentarias. Departamento de Farmacia. Medellín, Antioquia, Colombia
| | - Andrea Salazar-Ospina
- Universidad de Antioquia. Facultad de Ciencias Farmacéuticas y Alimentarias. Departamento de Farmacia. Medellín, Antioquia, Colombia
| | - Juliana Madrigal-Cadavid
- Universidad de Antioquia. Facultad de Ciencias Farmacéuticas y Alimentarias. Departamento de Farmacia. Medellín, Antioquia, Colombia
| | - Daniel Pino-Marín
- Universidad de Antioquia. Facultad de Ciencias Farmacéuticas y Alimentarias. Departamento de Farmacia. Medellín, Antioquia, Colombia
| | - Pedro Amariles
- Universidad de Antioquia. Facultad de Ciencias Farmacéuticas y Alimentarias. Departamento de Farmacia. Medellín, Antioquia, Colombia
| |
Collapse
|
14
|
Collins JC, Chan MY, Schneider CR, Yan LR, Moles RJ. Measurement of the reliability of pharmacy staff and simulated patient reports of non-prescription medicine requests in community pharmacies. Res Social Adm Pharm 2021; 17:1198-1203. [DOI: 10.1016/j.sapharm.2020.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/10/2020] [Accepted: 09/08/2020] [Indexed: 01/05/2023]
|
15
|
Collins JC, Chong WW, de Almeida Neto AC, Moles RJ, Schneider CR. The simulated patient method: Design and application in health services research. Res Social Adm Pharm 2021; 17:2108-2115. [PMID: 33972178 DOI: 10.1016/j.sapharm.2021.04.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 03/06/2021] [Accepted: 04/25/2021] [Indexed: 11/16/2022]
Abstract
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.
Collapse
Affiliation(s)
- Jack C Collins
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - Wei Wen Chong
- Centre of Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | | | - Rebekah J Moles
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Carl R Schneider
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| |
Collapse
|
16
|
Amaratunge S, Harrison M, Perry D, Bond C, Ceulemans M, Foulon V, Clifford R, Seubert L. Assessing the reporting quality of simulated patient studies in pharmacy research using a novel checklist (CRiSP). Res Social Adm Pharm 2021; 18:2301-2307. [PMID: 33896748 DOI: 10.1016/j.sapharm.2021.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 03/12/2021] [Accepted: 04/05/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Use of simulated patients (SP) to assess the quality of pharmacy services and impact of interventions is increasing. The CRiSP (Checklist for Reporting research using Simulated Patient methodology) checklist was recently developed, assisting researchers to report items necessary to meet a minimum agreed standard. OBJECTIVE(S) To identify which CRiSP items were reported in SP studies for community pharmacy research, identify any gaps in reporting and describe the overall quality of reporting for the SP studies identified. METHODS Papers published during 2018-2020 using SP methodology in community pharmacy settings were identified from MEDLINE and Embase. The 50 most recent ones were selected. Data were extracted independently and in duplicate. Each paper received a coded numerical value denoting compliance with each item of CRiSP (1 = yes, 2 = no, 3 = unclear, 4 = not applicable, 5 = partially complete). Data were analysed using Microsoft Excel and reported as frequencies and percentages of each code for the checklist items, across the 50 papers. RESULTS No paper fulfilled all items in the CRiSP checklist. The mode(s) of delivery of SP assessments (item 17) was reported in all papers, while use of the term SP (item 1); number of SPs (4a); scenario details (9a); describing procedures12; data collection procedure (18); and ethics approval (23a) were reported in at least 80% of papers. Items not reported in over 50% of papers were: scenario development (8a), validation (8b) and flexibility (9b); materials used (10a) and copies of materials (10b); and procedures for SP identification (15). Researchers found interpretation of the checklist unclear and utilised working definitions to ensure consistency in coding. CONCLUSIONS This review identified that pharmacy research involving SP methodology is often inadequately reported by researchers. The CRiSP checklist is a comprehensive tool to assess the quality of SP methodology reporting but may require some refinement to ensure consistency in use.
Collapse
Affiliation(s)
- Suvini Amaratunge
- Division of Pharmacy, University of Western Australia, Perth, WA, Australia
| | - Morgan Harrison
- Division of Pharmacy, University of Western Australia, Perth, WA, Australia
| | - Danae Perry
- Division of Pharmacy, University of Western Australia, Perth, WA, Australia
| | - Christine Bond
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Michael Ceulemans
- Clinical Pharmacology and Pharmacotherapy, KU Leuven, Leuven, Belgium
| | - Veerle Foulon
- Clinical Pharmacology and Pharmacotherapy, KU Leuven, Leuven, Belgium
| | - Rhonda Clifford
- School of Allied Health, University of Western Australia, Perth, WA, Australia
| | - Liza Seubert
- Division of Pharmacy, University of Western Australia, Perth, WA, Australia.
| |
Collapse
|
17
|
Aujla N, Chen YF, Samarakoon Y, Wilson A, Grolmusová N, Ayorinde A, Hofer TP, Griffiths F, Brown C, Gill P, Mallen C, Sartori J, Lilford RJ. Comparing the use of direct observation, standardized patients and exit interviews in low- and middle-income countries: a systematic review of methods of assessing quality of primary care. Health Policy Plan 2021; 36:341-356. [PMID: 33313845 PMCID: PMC8058951 DOI: 10.1093/heapol/czaa152] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2020] [Indexed: 12/31/2022] Open
Abstract
Clinical records in primary healthcare settings in low- and middle-income countries (LMIC) are often lacking or of too poor quality to accurately assess what happens during the patient consultation. We examined the most common methods for assessing healthcare workers' clinical behaviour: direct observation, standardized patients and patient/healthcare worker exit interview. The comparative feasibility, acceptability, reliability, validity and practicalities of using these methods in this setting are unclear. We systematically review and synthesize the evidence to compare and contrast the advantages and disadvantages of each method. We include studies in LMICs where methods have been directly compared and systematic and narrative reviews of each method. We searched several electronic databases and focused on real-life (not educational) primary healthcare encounters. The most recent update to the search for direct comparison studies was November 2019. We updated the search for systematic and narrative reviews on the standardized patient method in March 2020 and expanded it to all methods. Search strategies combined indexed terms and keywords. We searched reference lists of eligible articles and sourced additional references from relevant review articles. Titles and abstracts were independently screened by two reviewers and discrepancies resolved through discussion. Data were iteratively coded according to pre-defined categories and synthesized. We included 12 direct comparison studies and eight systematic and narrative reviews. We found that no method was clearly superior to the others-each has pros and cons and may assess different aspects of quality of care provision by healthcare workers. All methods require careful preparation, though the exact domain of quality assessed and ethics and selection and training of personnel are nuanced and the methods were subject to different biases. The differential strengths suggest that individual methods should be used strategically based on the research question or in combination for comprehensive global assessments of quality.
Collapse
Affiliation(s)
- Navneet Aujla
- W-CAHRD, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Yen-Fu Chen
- W-CAHRD, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Yasara Samarakoon
- W-CAHRD, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Anna Wilson
- W-CAHRD, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Natalia Grolmusová
- W-CAHRD, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Abimbola Ayorinde
- W-CAHRD, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Timothy P Hofer
- Department of Medicine, UM Institute for Health Policy and Innovation, Building 16 3rd Floor, North Campus Research Centre, University of Michigan Medical School, Ann Arbor, MI 48109-2800 USA
| | - Frances Griffiths
- W-CAHRD, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Celia Brown
- W-CAHRD, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Paramjit Gill
- W-CAHRD, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Christian Mallen
- Keele School of Medicine, David Wetherall Building, Keele University, Keele, ST5 5BG, UK
| | - Jo Sartori
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Richard J Lilford
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| |
Collapse
|
18
|
Amaratunge S, Harrison M, Clifford R, Seubert L, Page A, Bond C. Developing a checklist for reporting research using simulated patient methodology (CRiSP): a consensus study. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2021; 29:218-227. [PMID: 33792718 DOI: 10.1093/ijpp/riaa002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 08/27/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Simulated patients are increasingly used to measure outcomes in health services but reporting is suboptimal. This study aims to create a checklist for the reporting of simulated patient (SP) methodology. METHODS This was a Delphi study. The authors of health service research studies using SP methodology were invited to participate. Round 1 questionnaire assessed the applicability of the TIDieR (Template for Intervention Description and Replication) reporting checklist for SP methodology and asked for rewording of/additional items. Responses were thematically analysed to generate Round 2 items in which participants rated each item for importance (seven-point Likert scale) and median, mode and IQR were calculated. In Round 3, participants were invited to rescore their Round 2 responses. Consensus was defined as an IQR ≤ 1 (Extremely important) and median ≤ 2 (Very important). All consensus items were considered for inclusion in the checklist. Similarly, worded items were rationalised and items not specific to SP methodology or other existing checklists were excluded. KEY FINDINGS Twenty-nine authors participated in Round 1 and a further seven for Rounds 2 and 3. Twenty-six responses were analysed for Round 1, 30 for Round 2 and 28 for Round 3. There was consensus on 29 of 54 items in Round 2 and 45 of 63 items in Round 3. The final checklist comprised 28 items. CONCLUSIONS A new reporting checklist to guide the reporting of studies, using simulated patients, complementary to CONSORT or STROBE, has been developed and will now be tested for usability.
Collapse
Affiliation(s)
- Suvini Amaratunge
- Discipline of Pharmacy, The University of Western Australia, Crawley, Western Australia, Australia
| | - Morgan Harrison
- Discipline of Pharmacy, The University of Western Australia, Crawley, Western Australia, Australia
| | - Rhonda Clifford
- School of Allied Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - Liza Seubert
- Discipline of Pharmacy, The University of Western Australia, Crawley, Western Australia, Australia
| | - Amy Page
- Centre for Medicine Use and Safety, Monash University, Parkville, Victoria, Australia
| | - Christine Bond
- Academic Primary Care, University of Aberdeen, Aberdeen, UK
| |
Collapse
|
19
|
Collins JC, MacKenzie M, Schneider CR, Chaar BB, Moles RJ. A mixed-method simulated patient approach to explore implicit bias in health care: A feasibility study in community pharmacy. Res Social Adm Pharm 2021; 17:553-559. [DOI: 10.1016/j.sapharm.2020.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 04/29/2020] [Accepted: 05/02/2020] [Indexed: 11/16/2022]
|
20
|
Cheo R, Ge G, Godager G, Liu R, Wang J, Wang Q. The effect of a mystery shopper scheme on prescribing behavior in primary care: Results from a field experiment. HEALTH ECONOMICS REVIEW 2020; 10:33. [PMID: 32974815 PMCID: PMC7517825 DOI: 10.1186/s13561-020-00290-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 09/10/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Health care systems in many countries are characterized by limited availability of provider performance data that can be used to design and implement welfare improving reforms in the health sector. We question whether a simple mystery shopper scheme can be an effective measure to improve primary care quality in such settings. METHODS Using a randomized treatment-control design, we conducted a field experiment in primary care clinics in a Chinese city. We investigate whether informing physicians of a forthcoming mystery shopper audit influences their prescribing behavior. The intervention effects are estimated using conditional fixed-effects logistic regression. The estimated coefficients are interpreted as marginal utilities in a choice model. RESULTS Our findings suggest that the mystery shopper intervention reduced the probability of prescribing overall. Moreover, the intervention had heterogeneous effects on different types of drugs. CONCLUSIONS This study provides new evidence suggesting that announced performance auditing of primary care providers could directly affect physician behavior even when it is not combined with pay-for-performance, or measures such as reminders, feedback or educational interventions.
Collapse
Affiliation(s)
- Roland Cheo
- Center for Economic Research, Shandong University, 27 Shanda Nanlu, Jinan, Shandong, 250100 P.R. China
| | - Ge Ge
- Department of Health Management and Health Economics, University of Oslo, P.O. Box 1089 Blindern, Oslo, 0317 Norway
| | - Geir Godager
- Department of Health Management and Health Economics, University of Oslo, P.O. Box 1089 Blindern, Oslo, 0317 Norway
- Health Services Research Unit, Akershus University Hospital, Sykehusveien 25, Nordbyhagen, 1478 Norway
| | - Rugang Liu
- School of Health Policy & Management, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, 211166 P.R. China
- Center for Global Health, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, 211166 P.R. China
| | - Jian Wang
- Dong Fureng Institute of Economic and Social Development, Wuhan University, 54 Lishi Hutong, Dongcheng District, Beijing, 100010 China
- Center for Health Economics and Management in School of Economics and Management, Wuhan University, 299 Bayi Road Wuchang District, Wuhan, 430072 China
| | - Qiqi Wang
- School of Economics, Xi’an University of Finance and Economics, 360 Changning Avenue, Chang’an District, Xi’an Shanxi, 710100 China
| |
Collapse
|
21
|
Langer B, Grimm S, Lungfiel G, Mandlmeier F, Wenig V. The Quality of Counselling for Oral Emergency Contraceptive Pills-A Simulated Patient Study in German Community Pharmacies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186720. [PMID: 32942744 PMCID: PMC7559115 DOI: 10.3390/ijerph17186720] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 09/10/2020] [Accepted: 09/11/2020] [Indexed: 12/23/2022]
Abstract
Background: In Germany, there are two different active substances, levonorgestrel (LNG) and ulipristal acetate (UPA), available as emergency contraception (the “morning after pill”) with UPA still effective even 72 to 120 h after unprotected sexual intercourse, unlike LNG. Emergency contraceptive pills have been available without a medical prescription since March 2015 but are still only dispensed by community pharmacies. The aim of this study was to determine the counselling and dispensing behaviour of pharmacy staff and the factors that may influence this behaviour in a scenario that intends that only the emergency contraceptive pill containing the active substance UPA is dispensed (appropriate outcome). Methods: A cross-sectional study was carried out in the form of a covert simulated patient study in a random sample of community pharmacies stratified by location in the German state of Mecklenburg-Vorpommern and reported in accordance with the STROBE statement. Each pharmacy was visited once at random by one of four trained test buyers. They simulated a product-based request for an emergency contraceptive pill, stating contraceptive failure 3.5 days prior as the reason. The test scenario and the evaluation forms are based on the recommended actions, including the checklist from the Federal Chamber of Pharmacies. Results: All 199 planned pharmacy visits were carried out. The appropriate outcome (dispensing of UPA) was achieved in 78.9% of the test purchases (157/199). A significant correlation was identified between the use of the counselling room and the use of a checklist (p < 0.001). The use of a checklist led to a significantly higher questioning score (p < 0.001). In a multivariate binary logistic regression analysis, a higher questioning score (adjusted odds ratio [AOR] = 1.41; 95% CI = 1.22–1.63; p < 0.001) and a time between 12:01 and 4:00 p.m. (AOR = 2.54; 95% CI = 1.13–5.73; p = 0.024) compared to 8:00 to 12:00 a.m. were significantly associated with achieving the appropriate outcome. Conclusions: In a little over one-fifth of all test purchases, the required dispensing of UPA did not occur. The use of a counselling room and a checklist, the use of a checklist and the questioning score as well as the questioning score and achieving the appropriate outcome are all significantly correlated. A target regulation for the use of a counselling room, an explicit guideline recommendation about the use of a checklist, an obligation for keeping UPA in stock and appropriate mandatory continuing education programmes should be considered.
Collapse
|
22
|
Ceballos M, Salazar-Ospina A, Sabater-Hernández D, Amariles P. Evaluation of the effects of a drug with fiscalized substance dispensation, health education, and pharmacovigilance continuing education program in Colombia drugstores and drugstores/pharmacies: study protocol of a multicenter, cluster-randomized controlled trial. Trials 2020; 21:545. [PMID: 32560735 PMCID: PMC7304186 DOI: 10.1186/s13063-020-04481-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 06/06/2020] [Indexed: 11/15/2022] Open
Abstract
Background Health disorders, due to the use of drugs with fiscalized substances, including controlled substances, have become a common problem in Colombia. Multiple reasons can help explain this problem, including self-medication, since access to these drugs may be easier. Also, there is a lack of knowledge that these drugs are safer than illicit drugs. The use of these drugs without a valid medical prescription and follow-up can have negative consequences such as drug abuse, addiction, and overdose, and eventually, have negative health consequences. Pharmacy staff is essential to both assure the correct drug use and minimize prescription errors to help outpatients have better management of their pharmacotherapy. For this reason, it is necessary to increase key competencies like knowledge, skills, and attitudes in the pharmacy staff of ambulatory (outpatients) pharmacies. Methods This study is a prospective, cluster-randomized, parallel-group, multicenter trial of drugstores and drugstores/pharmacies (ambulatory pharmacies). The study is designed to determine the effectiveness of a drug with fiscalized substance dispensation, health education, and pharmacovigilance continuing education program in drugstores and drugstores/pharmacies. Pharmacy staff will be randomly selected and assigned to one of the study groups (intervention or control). The intervention group will receive a continuing education program for over 12 months. The control group will receive only general information about the correct use of complex dosage forms. The primary objective is to evaluate the effectiveness of a continuing education program to improve pharmacy staff competencies (knowledge, skills, and attitudes) to improve the ambulatory (outpatient) pharmacy services: dispensation, health education, and pharmacovigilance of drugs with fiscalized substances. The secondary outcomes include (a) processes associated with the management of drugs with fiscalized substances in drugstores and drugstores/pharmacies, including regulation compliance; (b) degree of implementation of ambulatory (outpatient) pharmacy services targeting these drugs in drugstores and drugstores/pharmacies; (c) patient satisfaction with such services; and (d) pharmacy staff satisfaction with the continuing education program. Discussion This clinical trial will establish whether providing a continuing education program for the adequate utilization of drugs with fiscalized substances improves pharmacy staff competencies regarding these drugs. Trial registration ClinicalTrials.gov NCT03388567. Registered on 28 November 2017. First drugstore or drugstore/pharmacy randomized on December 1, 2018. Protocol version 0017102017MC
Collapse
Affiliation(s)
- Mauricio Ceballos
- Research Group on Pharmaceutical Promotion and Prevention, University of Antioquia, U.de.A. Calle 70 No 52-21, Medellin, Colombia.,Research Group on Pharmacy Regency Technology, University of Antioquia, Medellin, Colombia
| | - Andrea Salazar-Ospina
- Research Group on Pharmaceutical Promotion and Prevention, University of Antioquia, U.de.A. Calle 70 No 52-21, Medellin, Colombia.,Research Group on Pharmacy Regency Technology, University of Antioquia, Medellin, Colombia
| | | | - Pedro Amariles
- Research Group on Pharmaceutical Promotion and Prevention, University of Antioquia, U.de.A. Calle 70 No 52-21, Medellin, Colombia.
| |
Collapse
|
23
|
Langer B, Kunow C. Do north-eastern German pharmacies recommend a necessary medical consultation for acute diarrhoea? Magnitude and determinants using a simulated patient approach. F1000Res 2020; 8:1841. [PMID: 32089826 PMCID: PMC7014574 DOI: 10.12688/f1000research.21045.2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/27/2020] [Indexed: 02/05/2023] Open
Abstract
Background: In Germany, non-pharmacists (pharmacy technicians and pharmaceutical technical assistants) are permitted to advise on and sell medications in addition to pharmacists. The aim of this study was to determine if pharmacists and non-pharmacists referred patients to a medical consultation for a scenario in which consulting a doctor was mandatory ('appropriate outcome') and what the quality of questioning and - if a medication was dispensed - the quality of information provided were in this context. The study also aimed to determine which factors predicted a necessary referral to a doctor. Methods: A cross-sectional, covert simulated patient study was conducted in a random sample of community pharmacies stratified by location in the German state of Mecklenburg-Vorpommern. Each pharmacy was visited once by one of four trained investigators. They simulated a symptom-based request involving a grandmother with acute diarrhoea. A multivariate binary logistic regression analysis using potential variables from bivariate analysis was carried out to determine the predictors for a referral to a doctor. Results: All 199 planned visits were conducted. A necessary referral to a doctor was recommended in 59.8% (n=119) of all visits. The most commonly asked question was 'for whom is the medication?' (75.4%, n=150), while 'clarification by a doctor' was asked the least (17.6%, n=35). In 87.9% (n=175) of all visits a medication was dispensed. Multivariate analysis revealed that, unlike pharmacists, non-pharmacists have a 2.446 times higher likelihood of recommending a referral to a doctor (p = 0.044; 95% CI = 1.025-5.835). Conclusions: In almost half of the visits a necessary referral to a doctor was not recommended. Furthermore, the quality of questioning and the quality of information were below expectations. Moreover, involvement of non‑pharmacists was surprisingly identified as a relevant factor influencing the appropriate outcome.
Collapse
Affiliation(s)
- Bernhard Langer
- Department of Health, Nursing, Management, University of Applied Sciences Neubrandenburg, Neubrandenburg, Germany
| | - Christian Kunow
- Department of Health, Nursing, Management, University of Applied Sciences Neubrandenburg, Neubrandenburg, Germany
| |
Collapse
|
24
|
Shi L, Chang J, Liu X, Zhai P, Hu S, Li P, Hayat K, Kabba JA, Feng Z, Yang C, Jiang M, Zhao M, Hu H, Fang Y. Dispensing Antibiotics without a Prescription for Acute Cough Associated with Common Cold at Community Pharmacies in Shenyang, Northeastern China: A Cross-Sectional Study. Antibiotics (Basel) 2020; 9:E163. [PMID: 32268530 PMCID: PMC7235837 DOI: 10.3390/antibiotics9040163] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 03/29/2020] [Accepted: 04/03/2020] [Indexed: 01/21/2023] Open
Abstract
: The inappropriate use of antibiotics is a major health issue in China. We aimed to assess nonprescription antibiotic dispensing and assess pharmacy service practice at community pharmacies in Shenyang, northeastern China, and to compare these practices between pediatric and adult cases. A cross-sectional study was performed from March to May 2018 using the standardized client method. Two different simulated scenarios were presented at pharmacies, namely, pediatric and adult acute cough associated with a common cold. Of 150 pharmacy visits, 147 visits were completed (pediatric case: 73, adult case: 74). A total of 130 (88.4%) community pharmacies dispensed antibiotics without a prescription, with a significant difference between pediatric and adult cases (pediatric case, 79.5% versus adult case, 97.3%, p = 0.005). Symptoms were asked in most visits (pediatric case: 82.2%, adult case 82.4%). Patients' previous treatment and history of allergies were both inquired more frequently in the pediatric cases than in the adult cases. Medication advice was provided more often in the adult cases than in pediatric cases. Antibiotics were easily obtained without a prescription in Shenyang, especially for adult patients. Adequate inquiries and counseling had not occurred in most pharmacies.
Collapse
Affiliation(s)
- Li Shi
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (L.S.); (P.Z.); (S.H.); (P.L.); (K.H.); (J.A.K.); (Z.F.); (C.Y.); (M.J.); (M.Z.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
| | - Jie Chang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (L.S.); (P.Z.); (S.H.); (P.L.); (K.H.); (J.A.K.); (Z.F.); (C.Y.); (M.J.); (M.Z.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
| | - Xiaoxi Liu
- School of Business Administration, Shenyang Pharmaceutical University, Shenyang 110016 China;
| | - Panpan Zhai
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (L.S.); (P.Z.); (S.H.); (P.L.); (K.H.); (J.A.K.); (Z.F.); (C.Y.); (M.J.); (M.Z.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
| | - Shuchen Hu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (L.S.); (P.Z.); (S.H.); (P.L.); (K.H.); (J.A.K.); (Z.F.); (C.Y.); (M.J.); (M.Z.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
| | - Pengchao Li
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (L.S.); (P.Z.); (S.H.); (P.L.); (K.H.); (J.A.K.); (Z.F.); (C.Y.); (M.J.); (M.Z.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
| | - Khezar Hayat
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (L.S.); (P.Z.); (S.H.); (P.L.); (K.H.); (J.A.K.); (Z.F.); (C.Y.); (M.J.); (M.Z.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore 54000, Pakistan
| | - John Alimamy Kabba
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (L.S.); (P.Z.); (S.H.); (P.L.); (K.H.); (J.A.K.); (Z.F.); (C.Y.); (M.J.); (M.Z.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
| | - Zhitong Feng
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (L.S.); (P.Z.); (S.H.); (P.L.); (K.H.); (J.A.K.); (Z.F.); (C.Y.); (M.J.); (M.Z.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
| | - Caijun Yang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (L.S.); (P.Z.); (S.H.); (P.L.); (K.H.); (J.A.K.); (Z.F.); (C.Y.); (M.J.); (M.Z.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
| | - Minghuan Jiang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (L.S.); (P.Z.); (S.H.); (P.L.); (K.H.); (J.A.K.); (Z.F.); (C.Y.); (M.J.); (M.Z.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
| | - Mingyue Zhao
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (L.S.); (P.Z.); (S.H.); (P.L.); (K.H.); (J.A.K.); (Z.F.); (C.Y.); (M.J.); (M.Z.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
| | - Hao Hu
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa 999078, Macao, China;
| | - Yu Fang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (L.S.); (P.Z.); (S.H.); (P.L.); (K.H.); (J.A.K.); (Z.F.); (C.Y.); (M.J.); (M.Z.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
| |
Collapse
|
25
|
Bahta M, Tesfamariam S, Weldemariam DG, Yemane H, Tesfamariam EH, Alem T, Russom M. Dispensing of antibiotics without prescription and associated factors in drug retail outlets of Eritrea: A simulated client method. PLoS One 2020; 15:e0228013. [PMID: 31978180 PMCID: PMC6980490 DOI: 10.1371/journal.pone.0228013] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/06/2020] [Indexed: 11/18/2022] Open
Abstract
Dispensing antibiotics without prescription is irrational and can hasten the emergence and spread of antibiotic resistance. This study aims at determining the extent of this practice and its determinants in all drug retail outlets of Eritrea. A cross-sectional simulated client method was used to conduct the study. Data was collected between July and August 2019, entered and analyzed using Statistical Package for Social Science version 22. Descriptive analysis was performed using mean (standard deviation), median (interquartile range), frequency, percentage, as appropriate, for independent variables. Logistic regression, at bivariate and multivariate levels, along with odds ratio (95% confidence interval) was used to determine the association between the dispensing of antibiotics without prescription and independent variables. P-values less than 0.05 were considered as statistically significant. The extent of dispensing antibiotics without prescription was found to be 87.6% with the most frequently dispensed antibiotics being ciprofloxacin (47.8%) and co-trimoxazole (37.5%). Furthermore, 12.4% of the drug retail outlet attendants did not dispense antibiotics because they preferred a referral to health facilities (52.6%), were following administrative restrictions not to sell antibiotics (42.1%), or did not have the necessary antibiotics (31.6%). Private community pharmacies (AOR = 7.68, 95% CI: 1.67, 35.37; p = 0.009) and private drug shops (AOR = 10.65, 95% CI: 1.96, 57.93; p = 0.006) were more likely to dispense antibiotics compared to the governmental community pharmacies. Dispensing antibiotics without prescription was more likely to occur in the Maekel (central) region (AOR = 3.76, 95% CI: 1.19, 11.92; p = 0.024) compared to the remaining regions combined. In conclusion, the sales of antibiotics without prescription in the drug retail outlets of Eritrea is alarming which requires immediate attention from policymakers.
Collapse
Affiliation(s)
- Merhawi Bahta
- Department of Medical Sciences, Pharmacy Unit, Orotta College of Medicine and Health Sciences, Asmara, Eritrea
| | | | | | | | - Eyasu H. Tesfamariam
- Department of Statistics, Biostatistics and Epidemiology Unit, College of Science, Eritrean Institute of Technology, Mai Nefhi, Eritrea
| | - Tesfamariam Alem
- Department of Medical Sciences, Pharmacy Unit, Orotta College of Medicine and Health Sciences, Asmara, Eritrea
| | - Mulugeta Russom
- Eritrean Pharmacovigilance Center, National Medicines and Food Administration, Asmara, Eritrea
| |
Collapse
|
26
|
Chen J, Wang Y, Chen X, Hesketh T. Widespread illegal sales of antibiotics in Chinese pharmacies - a nationwide cross-sectional study. Antimicrob Resist Infect Control 2020; 9:12. [PMID: 31956401 PMCID: PMC6961359 DOI: 10.1186/s13756-019-0655-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 11/15/2019] [Indexed: 01/21/2023] Open
Abstract
Background Access to antibiotics without a prescription from retail pharmacies has been described as a major contributor to anti-microbial resistance (AMR) globally. In the context of high rates of AMR, the Chinese government has recently introduced strict policies regarding hospital antibiotic use, but the existing ban on antibiotic sales without prescription in retail pharmacies has not been strongly enforced. In 2016, a goal of prescription-only antibiotics by 2020 was announced. The objective of the study was to determine progress towards the 2020 goal, through estimating the proportion of retail pharmacies selling antibiotics without prescription across the three regions of mainland China. Methods Using the Simulated Patient method, we conducted a cross-sectional survey across purposively-sampled retail pharmacies in urban and rural areas of 13 provinces in eastern, central and western China. Medical students presented a scenario of a mild upper respiratory tract infection, following a strict three-step protocol. They recorded the pharmacy characteristics, and details of their experience, including at which step antibiotics were offered. Results Complete data were obtained from 1106 pharmacies. Antibiotics were obtained in 925 (83.6, 95% CI: 81.5, 85.8%) pharmacies without a prescription, 279 (25.2%) at Stage 1 (symptoms only described), 576 (52.1%) at stage 2 (asked for antibiotics), and 70 (6.3%) at Stage 3 (asked for penicillin or cephalosporins). There were significant differences between provinces, with antibiotic access (at any stage) ranging from 57.0% (57/100) in Zhejiang (81/82) to 98.8% in Guizhou. However, there were no significant differences in access to antibiotics by level of city, county, township or village (P = 0.25), whether the pharmacy was part of a chain or independent (P = 0.23), whether a licensed pharmacist was attending (P = 0.82) or whether there was a sign saying that prescriptions were required for antibiotics (P = 0.19). Conclusions It is easy to obtain antibiotics without a prescription in retail pharmacies in China, despite the fact it is against the law. This must be addressed as part of the wider anti-microbial stewardship effort which could include intense enforcement of the existing law, supported by a public education campaign.
Collapse
Affiliation(s)
- Jie Chen
- Zhejiang University School of Medicine, 866 Yuhangtang Road, Hangzhou, 310058 People’s Republic of China
| | - Yanmei Wang
- Zhejiang University School of Medicine, 866 Yuhangtang Road, Hangzhou, 310058 People’s Republic of China
| | - Xuejie Chen
- Zhejiang University School of Medicine, 866 Yuhangtang Road, Hangzhou, 310058 People’s Republic of China
- Department of Gastroenterology, Third Xiangya Hospital, Central South University, Changsha, 410013 Hunan Province People’s Republic of China
| | - Therese Hesketh
- Centre for Global Health, Zhejiang University School of Medicine, 866 Yuhangtang Road, Hangzhou, 310058 People’s Republic of China
- Institute for Global Health, University College London, 30 Guilford St, London, WC1N1EH UK
| |
Collapse
|
27
|
Reeves NE, Waite MC, Tuttle N, Bialocerkowski A. Simulated patient contributions to enhancing exercise physiology student clinical assessment skills. Adv Simul (Lond) 2019; 4:15. [PMID: 31890315 PMCID: PMC6923845 DOI: 10.1186/s41077-019-0097-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 03/29/2019] [Indexed: 01/22/2023] Open
Abstract
Background The aim of this study was to evaluate exercise physiology students' perceptions of two simulation-based learning modules focused on communication and interpersonal skills during history taking. Methods A prospective, repeated-measures cohort study was conducted with 15 participants. The study evaluated two simulation-based learning modules in a 1-year Graduate Diploma of Exercise Science program. Surveys were administered at four time points: prior to each module and following each module. Students rated their confidence in communication and history taking, and perception of preparedness for practice, motivation for learning, and benefits of undertaking simulation-based learning. Quantitative data were analyzed descriptively and by using repeated measures tests. Qualitative data underwent thematic analyses. Results Students reported a significant improvement in their confidence in communication (P = 0.043) and in two parameters related to history taking (P = 0.034 and 0.035) following the completion of the two modules. There was 96% agreement that the simulation-based learning better prepared students for practice as an exercise physiologist. Significant changes occurred in all aspects of motivation for learning (P ranging from < 0.001 to 0.036) except for usefulness, where there was a ceiling effect (medians of 7 on a 7-point scale). Qualitative analysis demonstrated benefit to participants around themes of experiential learning, realism, opportunity to develop clinical skills, and debriefing. Students also made suggestions with respect to the activity structure of the simulation-based learning modules. Conclusions The results of this study indicated that simulation-based learning employing SPs increased the confidence and preparedness of exercise physiology students for conducting history taking, a requisite exercise physiology skill. Future studies should include behavioral measures of skill attainment and include follow-up evaluation to appraise the application of these skills into clinical practice.
Collapse
Affiliation(s)
- Nathan E Reeves
- 1School of Allied Health Sciences, Gold Coast Campus, Griffith University, Southport, QLD 4222 Australia
| | - Monique C Waite
- 2School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD 4222 Australia
| | - Neil Tuttle
- 3Menzies Health Institute Queensland and School of Allied Health Sciences, Griffith University, Southport, QLD 4222 Australia
| | - Andrea Bialocerkowski
- 1School of Allied Health Sciences, Gold Coast Campus, Griffith University, Southport, QLD 4222 Australia
| |
Collapse
|
28
|
Steed L, Sohanpal R, Todd A, Madurasinghe VW, Rivas C, Edwards EA, Summerbell CD, Taylor SJC, Walton RT. Community pharmacy interventions for health promotion: effects on professional practice and health outcomes. Cochrane Database Syst Rev 2019; 12:CD011207. [PMID: 31808563 PMCID: PMC6896091 DOI: 10.1002/14651858.cd011207.pub2] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Community pharmacies are an easily accessible and cost-effective platform for delivering health care worldwide, and the range of services provided has undergone rapid expansion in recent years. Thus, in addition to dispensing medication, pharmacy workers within community pharmacies now give advice on a range of health-promoting behaviours that aim to improve health and to optimise the management of long-term conditions. However, it remains uncertain whether these health-promotion interventions can change the professional practice of pharmacy workers, improve health behaviours and outcomes for pharmacy users and have the potential to address health inequalities. OBJECTIVES To assess the effectiveness and safety of health-promotion interventions to change community pharmacy workers' professional practice and improve outcomes for users of community pharmacies. SEARCH METHODS We searched MEDLINE, Embase, CENTRAL, six other databases and two trials registers to 6 February 2018. We also conducted reference checking, citation searches and contacted study authors to identify any additional studies. SELECTION CRITERIA We included randomised trials of health-promotion interventions in community pharmacies targeted at, or delivered by, pharmacy workers that aimed to improve the health-related behaviour of people attending the pharmacy compared to no treatment, or usual treatment received in the community pharmacy. We excluded interventions where there was no interaction between pharmacy workers and pharmacy users, and those that focused on medication use only. DATA COLLECTION AND ANALYSIS We used standard procedures recommended by Cochrane and the Effective Practice and Organisation of Care review group for both data collection and analysis. We compared intervention to no intervention or to usual treatment using standardised mean differences (SMD) and 95% confidence intervals (95% CI) (higher scores represent better outcomes for pharmacy user health-related behaviour and quality of life, and lower scores represent better outcomes for clinical outcomes, costs and adverse events). Interpretation of effect sizes (SMD) was in line with Cochrane recommendations. MAIN RESULTS We included 57 randomised trials with 16,220 participants, described in 83 reports. Forty-nine studies were conducted in high-income countries, and eight in middle-income countries. We found no studies that had been conducted in low-income countries. Most interventions were educational, or incorporated skills training. Interventions were directed at pharmacy workers (n = 8), pharmacy users (n = 13), or both (n = 36). The clinical areas most frequently studied were diabetes, hypertension, asthma, and modification of cardiovascular risk. Duration of follow-up of interventions was often unclear. Only five studies gave details about the theoretical basis for the intervention, and studies did not provide sufficient data to comment on health inequalities. The most common sources of bias were lack of protection against contamination - mainly in individually randomised studies - and inadequate blinding of participants. The certainty of the evidence for all outcomes was moderate. We downgraded the certainty because of the heterogeneity across studies and evidence of potential publication bias. Professional practice outcomes We conducted a narrative analysis for pharmacy worker behaviour due to high heterogeneity in the results. Health-promotion interventions probably improve pharmacy workers' behaviour (2944 participants; 9 studies; moderate-certainty evidence) when compared to no intervention. These studies typically assessed behaviour using a simulated patient (mystery shopper) methodology. Pharmacy user outcomes Health-promotion interventions probably lead to a slight improvement in health-related behaviours of pharmacy users when compared to usual treatment (SMD 0.43, 95% CI 0.14 to 0.72; I2 = 89%; 10 trials; 2138 participants; moderate-certainty evidence). These interventions probably also lead to a slight improvement in intermediate clinical outcomes, such as levels of cholesterol or glycated haemoglobin, for pharmacy users (SMD -0.43, 95% CI -0.65 to -0.21; I2 = 90%; 20 trials; 3971 participants; moderate-certainty evidence). We identified no studies that evaluated the impact of health-promotion interventions on event-based clinical outcomes, such as stroke or myocardial infarction, or the psychological well-being of pharmacy users. Health-promotion interventions probably lead to a slight improvement in quality of life for pharmacy users (SMD 0.29, 95% CI 0.08 to 0.50; I2= 82%; 10 trials, 2687 participants; moderate-certainty evidence). Adverse events No studies reported adverse events for either pharmacy workers or pharmacy users. Costs We found that health-promotion interventions are likely to be cost-effective, based on moderate-certainty evidence from five of seven studies that reported an economic evaluation. AUTHORS' CONCLUSIONS Health-promotion interventions in the community pharmacy context probably improve pharmacy workers' behaviour and probably have a slight beneficial effect on health-related behaviour, intermediate clinical outcomes, and quality of life for pharmacy users. Such interventions are likely to be cost-effective and the effects are seen across a range of clinical conditions and health-related behaviours. Nevertheless the magnitude of the effects varies between conditions, and more effective interventions might be developed if greater consideration were given to the theoretical basis of the intervention and mechanisms for effecting behaviour change.
Collapse
Affiliation(s)
- Liz Steed
- Queen Mary University of LondonCentre for Primary Care and Public Health, Barts and The London School of Medicine and DentistryBlizard Institute, Yvonne Carter Building58 Turner StreetLondonUKE1 2AT
| | - Ratna Sohanpal
- Queen Mary University of LondonCentre for Primary Care and Public Health, Barts and The London School of Medicine and DentistryBlizard Institute, Yvonne Carter Building58 Turner StreetLondonUKE1 2AT
| | - Adam Todd
- Newcastle UniversitySchool of PharmacyQueen Victoria RoadNewcastle upon TyneUKNE1 7RU
| | - Vichithranie W Madurasinghe
- Queen Mary University of LondonCentre for Primary Care and Public Health, Barts and The London School of Medicine and DentistryBlizard Institute, Yvonne Carter Building58 Turner StreetLondonUKE1 2AT
| | - Carol Rivas
- University College LondonDepartment of Social Science, UCL Institute of Education18 Woburn SquareLondonUKWC1H 0NR
| | - Elizabeth A Edwards
- Queen Mary University of LondonCentre for Primary Care and Public Health, Barts and The London School of Medicine and DentistryBlizard Institute, Yvonne Carter Building58 Turner StreetLondonUKE1 2AT
| | - Carolyn D Summerbell
- Durham UniversityDepartment of Sport and Exercise Sciences42 Old ElvetDurhamUKDH13HN
| | - Stephanie JC Taylor
- Queen Mary University of LondonCentre for Primary Care and Public Health, Barts and The London School of Medicine and DentistryBlizard Institute, Yvonne Carter Building58 Turner StreetLondonUKE1 2AT
- Queen Mary University of LondonAsthma UK Centre for Applied ResearchLondonUK
| | - RT Walton
- Queen Mary University of LondonCentre for Primary Care and Public Health, Barts and The London School of Medicine and DentistryBlizard Institute, Yvonne Carter Building58 Turner StreetLondonUKE1 2AT
- Queen Mary University of LondonAsthma UK Centre for Applied ResearchLondonUK
| | | |
Collapse
|
29
|
Langer B, Kunow C. Do north-eastern German pharmacies recommend a necessary medical consultation for acute diarrhoea? Magnitude and determinants using a simulated patient approach. F1000Res 2019; 8:1841. [DOI: 10.12688/f1000research.21045.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/22/2019] [Indexed: 11/20/2022] Open
Abstract
Background: To determine if pharmacy staff in Germany referred patients to a medical consultation for a scenario in which consulting a doctor was mandatory (‘appropriate outcome’) and what the quality of questioning and – if a medication was dispensed – the quality of information provided were in this context. Moreover, to determine which factors predicted a necessary referral to a doctor. Methods: A cross-sectional covert simulated patient study was conducted in a random sample of community pharmacies stratified by location in the German state of Mecklenburg-Vorpommern. Each pharmacy was visited once by one of four trained investigators. They simulated a symptom-based request involving a grandmother with acute diarrhoea. A multivariate binary logistic regression analysis using potential variables from bivariate analysis was carried out to determine the predictors for a referral to a doctor. Results: All 199 planned visits were conducted. A necessary referral to a doctor was recommended in 59.8% (n=119) of all test purchases. Multivariate analysis revealed that a non-pharmacist as opposed to a pharmacist and two or more questions as opposed to no questions were significantly associated with a referral to a doctor. Conclusions: Regarding the necessary referral to a doctor, an enormous potential for improvement was revealed for community pharmacies in the German state of Mecklenburg-Vorpommern. The results should make both the Mecklenburg-Vorpommern pharmacy association and legislators aware of the need to significantly escalate their quality management efforts.
Collapse
|
30
|
Langer B, Kunow C. Medication dispensing, additional therapeutic recommendations, and pricing practices for acute diarrhoea by community pharmacies in Germany: a simulated patient study. Pharm Pract (Granada) 2019; 17:1579. [PMID: 31592298 PMCID: PMC6763311 DOI: 10.18549/pharmpract.2019.3.1579] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 09/08/2019] [Indexed: 02/05/2023] Open
Abstract
Background: In Germany over-the-counter medications (OTC) – which since 2004 are no longer subject to binding prices – can only be purchased in pharmacies. Pharmacy owners and their staff therefore have a special responsibility when dispensing, advising on and setting the prices of medications. Objective: The aim of this study was to assess medication dispensing, additional therapeutic recommendations and pricing practices for acute diarrhoea in adults and to evaluate the role of the patient’s approach (symptom-based versus medication-based request) in determining the outcome of these aspects. Methods: A cross-sectional study was conducted from 1 May to 31 July 2017 in all 21 community pharmacies in a medium-sized German city. Symptom-based and medication-based scenarios related to self-medication of acute diarrhoea were developed and used by five simulated patients (SPs) in all of the pharmacies (a total of 84 visits). Differentiating between the different test scenarios in terms of the commercial and active ingredient names and also the prices of the medications dispensed, the SPs recorded on collection forms whether the scenario involved generic products or original preparations as well as whether recommendations were made during the test purchases regarding an additional intake of fluids. Results: In each of the 84 test purchases one preparation was dispensed. However, a preparation for oral rehydration was not sold in a single test purchase. On the other hand, in 74/84 (88%) of test purchases, medications with the active ingredient loperamide were dispensed. In only 35/84 (42%) of test purchases, the patient was also recommended to ensure an ‘adequate intake of fluids’ in addition to being dispensed a medication. In symptom-based scenarios significantly more expensive medications were dispensed compared to the medication-based scenarios (Wilcoxon signed rank test: z = -4.784, p < 0.001, r = 0.738). Also within the different scenarios there were enormous price differences identified – for example, in the medication-based scenarios, even for comparable loperamide generics the cheapest preparation cost EUR 1.99 and the most expensive preparation cost EUR 4.53. Conclusions: Oral rehydration was not dispensed and only occasionally was an adequate intake of fluids recommended. There were also enormous price differences both between and within the scenarios investigated.
Collapse
Affiliation(s)
- Bernhard Langer
- Department of Health, Nursing, Management, University of Applied Sciences Neubrandenburg. Neubrandenburg (Germany).
| | - Christian Kunow
- Research Associate. Department of Health, Nursing, Management, University of Applied Sciences Neubrandenburg. Neubrandenburg (Germany).
| |
Collapse
|
31
|
Björnsdottir I, Granas AG, Bradley A, Norris P. A systematic review of the use of simulated patient methodology in pharmacy practice research from 2006 to 2016. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2019; 28:13-25. [PMID: 31397533 DOI: 10.1111/ijpp.12570] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 07/09/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Simulated patient (SP) methodology (mystery shopping) is used increasingly to assess quality of pharmacy services, and evaluate impact of interventions. Our objective was to review papers reporting on the use of SP methodology in pharmacy practice research 2006-2016 in community pharmacies worldwide. METHODS We searched EMBASE and MEDLINE for papers reporting on the use of mystery shopping in pharmacy settings, using a wide range of terms for SPs, based on previous review. We removed irrelevant papers, duplicates, papers not written in English, and review papers and reviewed remaining papers. Two reviewers carried out data abstraction, using the same tool as the previous review and inserting data into Excel, focusing on how the SP methodology is used. KEY FINDINGS A total of 148 papers from 52 countries from all regions of the world were included in the review. A wide range of terms described the method, and simulated patient was the most common (49 papers). Most studies were cross-sectional (124), and most investigated only community pharmacies (115). The most common aim was to evaluate some aspect of pharmacists' or other staff's advice and counselling (94). Number of visits is 2-7785. Many papers did not cover details, such as number of visits planned, and carried out, scenario used, training and background of SPs, and ethical approval for the study. CONCLUSIONS The use of SP methodology has increased substantially in the field of pharmacy over the past decade. This is a useful method in a wide range of countries and settings. Greater detail is required in reporting.
Collapse
Affiliation(s)
| | | | - Amanda Bradley
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Pauline Norris
- School of Pharmacy, University of Otago, Dunedin, New Zealand
| |
Collapse
|
32
|
Smith H, Whyte S, Chan HF, Kyle G, Lau ETL, Nissen LM, Torgler B, Dulleck U. Pharmacist Compliance With Therapeutic Guidelines on Diagnosis and Treatment Provision. JAMA Netw Open 2019; 2:e197168. [PMID: 31314116 PMCID: PMC6647553 DOI: 10.1001/jamanetworkopen.2019.7168] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
IMPORTANCE Misuse and overselling of over-the-counter pharmaceuticals poses a major burden on both private and public health expenditures. OBJECTIVE To seek evidence on whether over-the-counter medication dispensing behavior complies or conflicts with the protocols indicated in practice standards and guidelines of a national professional pharmacy organization. DESIGN, SETTING, AND PARTICIPANTS This quality improvement study was undertaken in 205 pharmacies in the wider Brisbane, Australia, area. Two standardized patient (SP) scenarios were developed to evaluate noncompliant behavior. Data collection for scenario 1 was conducted between November 23 and December 9, 2016. Data collection for scenario 2 was conducted between September 1 and 28, 2017. A 2-sample test of proportions and a probit regression model were used to evaluate the likelihood of noncompliant treatments and overtreatments in each case scenario. Statistical analysis was performed from January 30 to June 21, 2018, and revised in May 2019. MAIN OUTCOMES AND MEASURES Outcomes were the observed likelihood of noncompliant treatments and overtreatments. Noncompliance is defined as treatments not complying with practice standards and guidelines set by the professional pharmacy society. Noncompliant treatments include undertreatment (patient did not receive necessary treatment) and overtreatments (patient was supplied with more than sufficient treatments) in both scenarios. RESULTS In scenario 1, 9 trained female SPs visited 89 pharmacies to request emergency hormonal contraception from pharmacy staff. In 45 cases, SPs reported having unprotected intercourse within the last 24 hours (case 1A), and in 44 cases, SPs reported having unprotected intercourse more than 72 hours ago (case 1B), which is past the efficacy threshold of over-the-counter emergency hormonal contraception. In scenario 2, 11 SPs (5 male and 6 female) visited 150 pharmacies (154 visits in total) to request treatment for family members or a partner with symptoms indicating bacterial conjunctivitis (case 2A; n = 73) or viral conjunctivitis (case 2B; n = 81). In scenario 1-dispensing emergency hormonal contraception when physician referral is recommended-21 of 44 pharmacists (47.7%) in case 1B violated the recommendation by selling the over-the-counter medication. With the inclusion of both no physician referral and emergency hormonal contraception sold, this rate increased to 79.5% (35 of 44 pharmacists). In scenario 2-1 case each of bacterial and viral conjunctivitis-overtreatment occurred in 55 of 154 cases (35.7%). In both scenarios, 140 of 243 pharmacies (57.6%) followed dispensing behavior compliant with the protocol, while 76 of 243 pharmacies (31.3%) involved some form of overtreatment or overselling of medication. Some evidence of an association between sex of SP and pharmacist was also found. CONCLUSIONS AND RELEVANCE Although the market for dispensing over-the-counter medication in Australia is regulated, relatively high rates of overtreatment and some cases of undertreatment were observed in this study. Given the unintended adverse effects, including overuse of antibiotics and corticosteroids, these observations suggest the advisability of regulatory intervention ensuring compliance with professional protocols.
Collapse
Affiliation(s)
- Harriet Smith
- School of Economics and Finance, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Stephen Whyte
- School of Economics and Finance, Queensland University of Technology, Brisbane, Queensland, Australia
- Centre for Behavioural Economics, Society and Technology, Brisbane, Queensland, Australia
| | - Ho Fai Chan
- School of Economics and Finance, Queensland University of Technology, Brisbane, Queensland, Australia
- Centre for Behavioural Economics, Society and Technology, Brisbane, Queensland, Australia
| | - Gregory Kyle
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Esther T. L. Lau
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Lisa M. Nissen
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Benno Torgler
- School of Economics and Finance, Queensland University of Technology, Brisbane, Queensland, Australia
- Centre for Behavioural Economics, Society and Technology, Brisbane, Queensland, Australia
- Center for Research in Economics, Management and the Arts, Zürich, Switzerland
| | - Uwe Dulleck
- School of Economics and Finance, Queensland University of Technology, Brisbane, Queensland, Australia
- Centre for Behavioural Economics, Society and Technology, Brisbane, Queensland, Australia
- Crawford School of Public Policy, Australian National University, Canberra, Australian Capital Territory, Australia
| |
Collapse
|
33
|
Mináriková D, Fazekaš T, Minárik P, Jurišová E. Assessment of patient counselling on the common cold treatment at Slovak community pharmacies using mystery shopping. Saudi Pharm J 2019; 27:574-583. [PMID: 31061627 PMCID: PMC6488828 DOI: 10.1016/j.jsps.2019.02.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 02/09/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Up to now, there have been no data on patient counselling in the Slovak community pharmacies. The literature provides a wide range of activities for which mystery shopping methodology be used, including assessment of patient counselling. AIMS AND OBJECTIVES To assess patient counselling on the common cold treatment with OTC medicine containing zinc provided by Slovak community pharmacists. To analyse this counselling considering the set scenarios, counsellors and their age. METHODS 54 pharmacy students visited 270 different community pharmacies throughout Slovakia in 2 weeks in October 2016 to conduct mystery shopping with set scenarios. For assessment of patient counselling, we defined Counselling Performance. It was conceptualised as weighted mean percentage counselling successes rate of its three categories (Identification, Information and Communication) and their weights. Individual perception of counselling evaluated separately. Student t-test and Person's chi-squared test (p < 0.05) and Cohen delta were used for comparing outcomes and effect size of counselling. A simple linear regression was used to find relationships. RESULTS The total Counselling Performance was 39.0 ± 22.4%, Identification 30.6 ± 28.7%, Information 39.8 ± 25.1% and Communication 74.3 ± 11.5%. 26.3% pharmacies achieved the average Counselling Performance (41-60%). Subjective Perception had a success rate of 73.4 ± 21.2%, but it could be predicted by the Counselling Performance and the success rate of the three categories only in 1/5 pharmacies. Spontaneous counselling was provided more by pharmacy technicians (p = 0.0009). The duration of counselling was similar when comparing both scenarios, counsellors and their age. The product-requested scenario achieved a higher success rate in the Information category (p = 0.0304; d = 0.27). Pharmacists achieved a higher Counselling Performance (p < 0.0001; d = 0.48) and success rate in categories Identification (p = 0.0001, d = 0.46), Information (p = 0.0004, d = 0.37), and Perception (p = 0.0007; d = 0.54). The estimated age of counsellors did not have any impact on the counselling. CONCLUSION Patient counselling on the common cold showed a suboptimal level, particularly considering its content. In the study, we found a significant relationship between the success of counselling and counsellors.
Collapse
Affiliation(s)
- Daniela Mináriková
- Department of Organisation and Management in Pharmacy, Faculty of Pharmacy, Comenius University in Bratislava, Odbojarov 10, SK-83232 Bratislava, Slovak Republic
| | - Tomáš Fazekaš
- Department of Physical Chemistry of Drugs, Faculty of Pharmacy, Comenius University in Bratislava, Odbojarov 10, SK-83232 Bratislava, Slovak Republic
| | - Peter Minárik
- St. Elisabeth University of Health and Social Work, Palackeho 1, 811 02 Bratislava, Slovak Republic
| | - Erika Jurišová
- Department of Languages, Faculty of Pharmacy, Comenius University in Bratislava, Odbojarov 10, SK-83232 Bratislava, Slovak Republic
| |
Collapse
|
34
|
Engl E, Sgaier SK. CUBES: A practical toolkit to measure enablers and barriers to behavior for effective intervention design. Gates Open Res 2019. [DOI: 10.12688/gatesopenres.12923.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A pressing goal in global development and other sectors is often to understand what drives people’s behaviors, and how to influence them. Yet designing behavior change interventions is often an unsystematic process, hobbled by insufficient understanding of contextual and perceptual behavioral drivers and a narrow focus on limited research methods to assess them. We propose a toolkit (CUBES) of two solutions to help programs arrive at more effective interventions. First, we introduce a novel framework of behavior, which is a practical tool for programs to structure potential drivers and match corresponding interventions. This evidence-based framework was developed through extensive cross-sectoral literature research and refined through application in large-scale global development programs. Second, we propose a set of descriptive, experimental, and simulation approaches that can enhance and expand the methods commonly used in global development. Since not all methods are equally suited to capture the different types of drivers of behavior, we present a decision aid for method selection. We recommend that existing commonly used methods, such as observations and surveys, use CUBES as a scaffold and incorporate validated measures of specific types of drivers in order to comprehensively test all the potential components of a target behavior. We also recommend under-used methods from sectors such as market research, experimental psychology, and decision science, which programs can use to extend their toolkit and test the importance and impact of key enablers and barriers. The CUBES toolkit enables programs across sectors to streamline the process of conceptualizing, designing, and optimizing interventions, and ultimately to change behaviors and achieve targeted outcomes.
Collapse
|
35
|
Engl E, Sgaier SK. CUBES: A practical toolkit to measure enablers and barriers to behavior for effective intervention design. Gates Open Res 2019; 3:886. [PMID: 31294419 PMCID: PMC6601426 DOI: 10.12688/gatesopenres.12923.2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2019] [Indexed: 02/04/2023] Open
Abstract
A pressing goal in global development and other sectors is often to understand what drives people’s behaviors, and how to influence them. Yet designing behavior change interventions is often an unsystematic process, hobbled by insufficient understanding of contextual and perceptual behavioral drivers and a narrow focus on limited research methods to assess them. We propose a toolkit (CUBES) of two solutions to help programs arrive at more effective interventions. First, we introduce a novel framework of behavior, which is a practical tool for programs to structure potential drivers and match corresponding interventions. This evidence-based framework was developed through extensive cross-sectoral literature research and refined through application in large-scale global development programs. Second, we propose a set of descriptive, experimental, and simulation approaches that can enhance and expand the methods commonly used in global development. Since not all methods are equally suited to capture the different types of drivers of behavior, we present a decision aid for method selection. We recommend that existing commonly used methods, such as observations and surveys, use CUBES as a scaffold and incorporate validated measures of specific types of drivers in order to comprehensively test all the potential components of a target behavior. We also recommend under-used methods from sectors such as market research, experimental psychology, and decision science, which programs can use to extend their toolkit and test the importance and impact of key enablers and barriers. The CUBES toolkit enables programs across sectors to streamline the process of conceptualizing, designing, and optimizing interventions, and ultimately to change behaviors and achieve targeted outcomes.
Collapse
Affiliation(s)
- Elisabeth Engl
- Surgo Foundation, Washington, District of Columbia, 20001, USA
| | - Sema K Sgaier
- Surgo Foundation, Washington, District of Columbia, 20001, USA.,Department of Global Health & Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Global Health, University of Washington, Seattle, Washington, USA
| |
Collapse
|
36
|
Janse van Rensburg B, Freeman CR, Ford PJ, Taing MW. Investigating the management of potentially cancerous nonhealing mouth ulcers in Australian community pharmacies. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:415-423. [PMID: 30246463 DOI: 10.1111/hsc.12661] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 08/24/2018] [Accepted: 08/27/2018] [Indexed: 05/20/2023]
Abstract
We sought to examine the management and referral of nonhealing mouth ulcer presentations in Australian community pharmacies in the Greater Brisbane region. Trained simulated patients visited 220 randomly selected community pharmacies within the Greater Brisbane region in 2016. Simulated patients enacted two nonhealing (>1 month) mouth ulcer scenarios: A direct product request (DPR) (n = 110) and a symptom-based request (SBR) (n = 110). Results were documented and evaluated against Australian national pharmacy practice standards. Referral rates for pharmacy staff (pharmacist, pharmacy assistant or mixed-pharmacist and assistant) were also assessed. Australian pharmacy practice standards recommend staff ask six key questions during SBR and DPR consultations to enable informed decision-making. Two questions relating to identifying the patient and their symptoms were asked in the majority of interactions (76% and 69% respectively); the remaining four questions relating to symptom duration, treatments tried, other medications, and medical conditions were enquired in only 32%, 53%, 31%, and 27% of interactions, respectively. Simulated patients were referred to the doctor/dentist in only 11.8% of all interactions (both scenarios requiring referral). Overall, staff handling of nonhealing mouth ulcer consultations was suboptimal compared to national professional standards. In particular, duration of the nonhealing mouth ulcer was enquired in less than one-third of consultations potentially resulting in low referral rates by staff. This study identifies the need for increased oral cancer awareness and education for community pharmacy staff and reinforcing the importance of practising according to professional standards to effectively screen for potentially cancerous nonhealing mouth lesions.
Collapse
Affiliation(s)
| | | | - Pauline J Ford
- School of Dentistry, The University of Queensland, QLD, Australia
| | - Meng-Wong Taing
- School of Pharmacy, The University of Queensland, QLD, Australia
| |
Collapse
|
37
|
El Hajj MS, Awaisu A, Kheir N, Mohamed MHN, Haddad RS, Saleh RA, Alhamad NM, Almulla AM, Mahfoud ZR. Evaluation of an intensive education program on the treatment of tobacco-use disorder for pharmacists: a study protocol for a randomized controlled trial. Trials 2019; 20:25. [PMID: 30621772 PMCID: PMC6324165 DOI: 10.1186/s13063-018-3068-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 11/21/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Tobacco use is presently responsible for the death of over seven million people across the world. In Qatar, it is one of the main causes of premature deaths and preventable diseases. To reduce tobacco use, Qatar has ratified the World Health Organization (WHO)'s Framework Convention on Tobacco Control (FCTC) and has implemented many tobacco-control initiatives. In spite of these measures, tobacco use is still considered a public health threat in Qatar. Pharmacists practicing in retail/community pharmacy settings are often the first port of call for individuals requiring general health advice. Evidence has proven that they have a pivotal role in health promotion and disease prevention including tobacco cessation. However, pharmacists in Qatar are not actively involved in tobacco control and many have not received any education or training about smoking cessation counseling in the past. In an effort to build the capacity of pharmacists towards tobacco control in Qatar, the aim of the proposed study is to design, implement, and evaluate an intensive education program on tobacco dependence treatment for pharmacists in Qatar. METHODS/DESIGN The study will be a prospective randomized controlled trial comparing an intensive tobacco-related education program versus non-tobacco-related training on pharmacists' tobacco-use-related knowledge, attitudes, self-efficacy, and skills. Community pharmacists practicing in Qatar will be eligible for participation in the study. A random sample of pharmacists will be selected for participation. Consenting participants will be randomly allocated to intervention or control groups. Participants in the intervention group will receive an intensive education program delivered by a multi-disciplinary group of educators, researchers, and clinicians with expertise in tobacco cessation. A short didactic session on a non-tobacco-related topic will be delivered to pharmacists in the control group. The study has two primary outcomes: post-intervention tobacco-related knowledge and post-intervention skills for tobacco cessation assessed using a multiple-choice-based evaluation instrument and an Objective Structured Clinical Examination (OSCE), respectively. The secondary study outcomes are post-intervention attitudes towards tobacco cessation and self-efficacy in tobacco-cessation interventions assessed using a survey instrument. An additional secondary study outcome is the post-intervention performance difference in relation to tobacco-cessation skills in the practice setting assessed using the simulated client approach. DISCUSSION If demonstrated to be effective, this education program will be considered as a model that Qatar and the Middle East region can apply to overcome the burden of tobacco-use disorder. TRIAL REGISTRATION ClinicalTrials.gov, ID: NCT03518476 . Registered on 8 May 2018. Version 1/22 June 2018.
Collapse
Affiliation(s)
| | - Ahmed Awaisu
- College of Pharmacy, Qatar University, Doha, 2713 Qatar
| | - Nadir Kheir
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | | | | | | | | | - Ahmad Mohd Almulla
- Tobacco Control Center-WHO Collaborating Center, Hamad Medical Corporation, Doha, Qatar
| | | |
Collapse
|
38
|
Wigmore BC, Collins JC, Schneider CR, Arias D, Moles RJ. Ability of Pharmacy Students, Pharmacists and Pharmacy Support Staff to Manage Childhood Fever via Simulation. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2018; 82:6445. [PMID: 30643307 PMCID: PMC6325453 DOI: 10.5688/ajpe6445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 11/16/2017] [Indexed: 06/09/2023]
Abstract
Objective. To ascertain how pharmacy students (novices) and pharmacy staff (experts) respond to a childhood fever scenario. Methods. Data were collected from 65 second year students and 51 fourth (final) year students in an over-the-counter fever scenario during assessment tasks. Data from pharmacy staff were collected via mystery shopping conducted over nine weeks between March and October 2015. All encounters were immediately scored by the trained simulated client, and immediate feedback was provided for pharmacy staff and fourth year students. Questioning scores and proportions of competent participants were collected in all groups. Statistical comparative analyses were made between fourth year students and pharmacy staff. Pharmacy staff scores were also tracked over time. Results. Second year students performed well, achieving a median questioning score of 100%. Conversely, pharmacy staff scored 22%. A large proportion of the fourth year students and pharmacy staff achieved appropriate outcomes (92% and 65%, respectively); however, a smaller proportion of second year students performed well (52%). The pharmacy staff achieved statistical improvements over time for median questioning scores. Conclusion. Protocol compliant questioning appears to decline with experience. However, experienced counselors are more likely to provide appropriate patient advice. Further improvements in outcomes can also occur when staff are provided feedback and coaching. Mystery shopping simulations can be used as a valuable educational tool.
Collapse
Affiliation(s)
- Beatrice C. Wigmore
- King’s College, London, United Kingdom
- The University of Sydney, Sydney, Australia
| | | | | | | | | |
Collapse
|
39
|
Sakeena M, Bennett AA, McLachlan AJ. Non-prescription sales of antimicrobial agents at community pharmacies in developing countries: a systematic review. Int J Antimicrob Agents 2018; 52:771-782. [DOI: 10.1016/j.ijantimicag.2018.09.022] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 08/28/2018] [Accepted: 09/29/2018] [Indexed: 11/24/2022]
|
40
|
Langer B, Bull E, Burgsthaler T, Glawe J, Schwobeda M, Simon K. Assessment of counselling for acute diarrhoea in German pharmacies: a simulated patient study. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2018; 26:310-317. [PMID: 28925071 PMCID: PMC6055702 DOI: 10.1111/ijpp.12405] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 08/21/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The aim of this study was to assess the quality of counselling provided for acute diarrhoea and to evaluate the role of the patient's approach and different user groups in determining the outcome of counselling. METHODS The simulated patient methodology was used in all 21 community pharmacies in a north-eastern German city. Four different scenarios related to self-medication of acute diarrhoea were developed and used in all the pharmacies (a total of 84 visits). The assessment form, completed immediately postvisit by the simulated patient, included 9 objective items scored using dichotomous scales to produce a scale from 0 to 9. After evaluating the data, every pharmacy received individual performance feedback to encourage behavioural changes and improve the quality of the counselling provided. KEY FINDINGS Overall, the quality of counselling was poor (mean score of 3.3/9 (37%)). The most common information provided was about dosage (87% of interactions), while the least common information given was about side effects (4% of interactions). The main effect was seen when comparing the product and symptom requests (F(1,60) = 24.748, P < 0.001, ωp2 = 0.277). There was no effect resulting from different user groups (F(1,28) = 0.237, P = 0.630, ωp2 = -0.026) and no interaction between the type of request and different user groups (F(1,28) = 3.395, P = 0.076, ωp2 = 0.073). CONCLUSIONS This study highlighted the current deficits in appropriate counselling provided by community pharmacies in Germany.
Collapse
Affiliation(s)
- Bernhard Langer
- Faculty of HealthNursingAdministrationUniversity of Applied Sciences NeubrandenburgNeubrandenburgGermany
| | - Elisa Bull
- Faculty of HealthNursingAdministrationUniversity of Applied Sciences NeubrandenburgNeubrandenburgGermany
| | - Tina Burgsthaler
- Faculty of HealthNursingAdministrationUniversity of Applied Sciences NeubrandenburgNeubrandenburgGermany
| | - Julia Glawe
- Faculty of HealthNursingAdministrationUniversity of Applied Sciences NeubrandenburgNeubrandenburgGermany
| | - Monique Schwobeda
- Faculty of HealthNursingAdministrationUniversity of Applied Sciences NeubrandenburgNeubrandenburgGermany
| | - Karen Simon
- Faculty of HealthNursingAdministrationUniversity of Applied Sciences NeubrandenburgNeubrandenburgGermany
| |
Collapse
|
41
|
El-Den S, Chen TF, Moles RJ, O'Reilly C. Assessing Mental Health First Aid Skills Using Simulated Patients. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2018; 82:6222. [PMID: 29606711 PMCID: PMC5869753 DOI: 10.5688/ajpe6222] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 03/08/2017] [Indexed: 05/11/2023]
Abstract
Objective. To evaluate mental health first aid (MHFA) skills using simulated patients and to compare self-reported confidence in providing MHFA with performance during simulated patient roleplays. Methods. Pharmacy students self-evaluated their confidence in providing MHFA post-training. Two mental health vignettes and an assessment rubric based on the MHFA Action Plan were developed to assess students' observed MHFA skills during audio-recorded simulated patient roleplays. Results. There were 163 students who completed the MHFA training, of which 88% completed self-evaluations. There were 84% to 98% of students who self-reported that they agreed or strongly agreed they were confident providing MHFA. Postnatal depression (PND) and suicide vignettes were randomly assigned to 36 students. More students participating in the PND roleplay took appropriate actions, compared to those participating in the suicide role-play. However, more students participating in the suicide role play assessed alcohol and/or drug use. Ten (71%) participants in the PND roleplay and six (40%) in the suicide roleplay either avoided using suicide-specific terminology completely or used multiple terms rendering their inquiry unclear. Conclusion. Self-evaluated confidence levels in providing MHFA did not always reflect observed performance. Students had difficulty addressing suicide with only half passing the suicide vignette and many avoiding suicide-specific terminology. This indicates that both self-reported and observed behaviors should be used for post-training assessments.
Collapse
Affiliation(s)
- Sarira El-Den
- The University of Sydney, New South Wales, Australia
| | | | | | | |
Collapse
|
42
|
Newlands RS, Power A, Young L, Watson M. Quality improvement of community pharmacy services: a prioritisation exercise. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2018; 26:39-48. [PMID: 28349646 PMCID: PMC5811898 DOI: 10.1111/ijpp.12354] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 01/18/2017] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Effective strategies are needed to translate knowledge (evidence) into practice to improve the quality of community pharmacy services. We report the first step of a novel knowledge translation process which involved the systematic identification and prioritisation of community pharmacy services in Scotland which were perceived to require improvement and/or guideline development. METHODS This process involved three stages and a stakeholder group comprising community pharmacists, policy makers, lay and pharmacy organisation representatives. A modified nominal group technique (NGT) was used for topic generation (August 2013) followed by an electronic Delphi survey (eDelphi), October-December 2013) and topic rationalisation (December 2013) based on feasibility, acceptability, and potential impact for practice improvement. KEY FINDINGS In total, 63 items were identified during the modified NGT which were categorised into 20 topics to form the starting point of the eDelphi. In total, 74 individuals (mostly community pharmacists) indicated an interest in the eDelphi, which achieved response rates of 63.5%, 67.6%, and 70.3%, respectively in Rounds 1, 2, and 3. Consensus was achieved with six topics: promoting the appropriate sale and supply of over-the-counter medicines; patient counselling for prescribed medication; pharmaceutical care to promote medication adherence; promotion and delivery of a Minor Ailment Scheme; pharmaceutical care of vulnerable patients; and effective use of community pharmacy workforce. Of these, the priority topic selected for the next stage of the programme was promoting the appropriate sale and supply of over-the-counter medicines. CONCLUSIONS This study adopted a systematic, inclusive, and rapid approach to identify priorities for community pharmacy practice improvement in Scotland.
Collapse
Affiliation(s)
- Rumana S. Newlands
- Health Services Research UnitUniversity of AberdeenForesterhillAberdeenUK
| | | | - Linda Young
- NHS Education for ScotlandDundee Dental Education CentreDundeeUK
| | - Margaret Watson
- Department of Pharmacy and PharmacologyUniversity of BathBath, UK
| |
Collapse
|
43
|
Collins JC, Schneider CR, Naughtin CL, Wilson F, de Almeida Neto AC, Moles RJ. Mystery shopping and coaching as a form of audit and feedback to improve community pharmacy management of non-prescription medicine requests: an intervention study. BMJ Open 2017; 7:e019462. [PMID: 29247115 PMCID: PMC5735410 DOI: 10.1136/bmjopen-2017-019462] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Jack Charles Collins
- Faculty of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia
| | | | | | - Frances Wilson
- Faculty of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Rebekah Jane Moles
- Faculty of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
44
|
Murphy AL, Hillier K, Ataya R, Thabet P, Whelan AM, O'Reilly C, Gardner D. A scoping review of community pharmacists and patients at risk of suicide. Can Pharm J (Ott) 2017; 150:366-379. [PMID: 29123596 DOI: 10.1177/1715163517733482] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Medications are commonly used in suicide attempts. Pharmacists are inextricably linked to medications and may have roles in helping those at risk of suicide. We conducted a scoping review to characterize the existing literature and make recommendations about future research. Methods We used a 6-step approach based on an existing scoping review methodological framework, including identifying the research question; identifying relevant studies and other literature; study and literature selection; data charting; collating, summarizing and reporting results; and dissemination of results. We searched electronic databases, various grey literature sources and mobile app stores. Results Thirty-five articles were included following screening of 1013 database citations. Of 1085 results from grey literature searches, we included 12. Most publications were opinion pieces (n = 22), followed by survey studies (n = 9), primarily assessing pharmacists' knowledge and attitudes. Themes included education and training to impact knowledge and attitudes, gatekeeping of medication supply, collaboration and integration, and role perception. Public perspectives on pharmacists' roles were limited. Conclusions Research regarding pharmacists' roles in the care of people at risk for suicide is limited. The areas that have dominated the literature include legal liability, especially with respect to gatekeeping medications, ethical decision making and education and training. Research is needed to determine what methods, outcomes and measures are required to best serve in building the evidence base for policy and practice decisions in this area.
Collapse
Affiliation(s)
- Andrea Lynn Murphy
- College of Pharmacy (Murphy, Hillier, Ataya, Thabet, Whelan), University of Sydney, Sydney, New South Wales, Australia
| | - Katelyn Hillier
- College of Pharmacy (Murphy, Hillier, Ataya, Thabet, Whelan), University of Sydney, Sydney, New South Wales, Australia
| | - Randa Ataya
- College of Pharmacy (Murphy, Hillier, Ataya, Thabet, Whelan), University of Sydney, Sydney, New South Wales, Australia
| | - Pierre Thabet
- College of Pharmacy (Murphy, Hillier, Ataya, Thabet, Whelan), University of Sydney, Sydney, New South Wales, Australia
| | - Anne Marie Whelan
- College of Pharmacy (Murphy, Hillier, Ataya, Thabet, Whelan), University of Sydney, Sydney, New South Wales, Australia
| | - Claire O'Reilly
- College of Pharmacy (Murphy, Hillier, Ataya, Thabet, Whelan), University of Sydney, Sydney, New South Wales, Australia
| | - David Gardner
- College of Pharmacy (Murphy, Hillier, Ataya, Thabet, Whelan), University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
45
|
Pharmacy student decision making in over-the-counter medicine supply: A critical incident study. Res Social Adm Pharm 2017; 14:749-757. [PMID: 28969886 DOI: 10.1016/j.sapharm.2017.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 09/25/2017] [Accepted: 09/25/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Various factors influence decision making in over-the-counter (OTC) medicine consultations, yet limited studies have focused, in-depth, on the thought process of pharmacy staff. This includes pharmacy students as pharmacists-in-training. AIM To explore the factors that influence pharmacy students' decisions in relation to OTC consultations and choice of OTC medicine/s. METHODS Semi-structured interviews using the critical incident technique were undertaken with ten pharmacy students in Australia, who also worked as part-time pharmacy staff. RESULTS Nine key themes were identified to influence pharmacy student decision making in OTC consultations, including customer response, confidence and scope of practice. Product requests were reported as more challenging due to customer expectations and experiences in other pharmacies, states or countries. Although negative customer response influenced some students to supply medicines in contradiction of evidence, an overarching concern for safety meant that a medicine was only supplied if unlikely to cause harm. Students reported developing confidence in OTC decision making more from real-life practice than university training; greater confidence was identified for inquiries more frequently experienced in the pharmacy. Students perceived that customers had assumptions around support staff, and were happier to talk to students than assistants. CONCLUSION This study further identified that OTC decision making is a complex process for pharmacy students. Additional opportunities for experiential learning within this area are suggested, such as work-based placements or in-class activities such as role-plays with simulated patients.
Collapse
|
46
|
Self-medication and non-prescription drug counseling: Illustrating profession uncertainty within Turkish pharmacy practice. Res Social Adm Pharm 2017; 14:718-726. [PMID: 29017755 DOI: 10.1016/j.sapharm.2017.09.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 07/14/2017] [Accepted: 09/05/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND Recommending effective minor ailment treatments and using non-prescription or over-the-counter (OTC) medicines is a pharmacist's duty. Although common in most European countries, self-medication counseling practices may differ from country to country. OBJECTIVES This study explored Turkish community pharmacists' attitudes concerning the present self-medication market, professional responsibilities toward patients' self-care, and the usefulness of e-learning for patients' counseling education. METHODS The study was comprised of three phases: initially, a document content analysis searched for relevant OTC regulatory and/or practice frameworks; secondly, qualitative individual interviews on self-medication with purposively selected Turkish community pharmacists were performed; finally, a focus group with practitioners and continuing education experts was conducted to deepen previous results. A thematic data analysis, based on the attitudinal theory, was conducted, supported by MAXQDA v12 software. RESULTS Sixteen documental sources allowed the extraction of three initial main themes: self-medication, classification of medicines and pharmacists' role. Individual interviews outlined four themes that informed the focus group discussion, which produced four new themes. Themes and their codes reflected dissimilar practitioners' cognitions towards OTCs, OTC usage and self-medication, particularly if compared to other European conceptualizations. Contradictory feelings towards the value of OTCs for professional development, e.g., patient counseling influenced by profit-based expectations, were identified. CONCLUSION Turkish community pharmacists and their minor ailments treatment competences have yet to thrive as a relevant professional intervention. There are risks of missing the best pharmacy practice standards, thus losing their contribution to rational self-care. Besides weakening the societal recognition of the profession to help individuals' everyday health decisions and well-being, there might be a reduced active role in public health.
Collapse
|
47
|
Management of common ailments requiring referral in the pharmacy: a mystery shopping intervention study. Int J Clin Pharm 2017; 39:697-703. [PMID: 28685179 DOI: 10.1007/s11096-017-0505-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 06/26/2017] [Indexed: 10/19/2022]
Abstract
Background Pharmacists can play a key role in managing ailments through their primary roles of supplying over-the-counter (non-prescription) medicines and advice-giving. It must be ensured that pharmacy staff practise in an evidence-based, guideline-compliant manner. To achieve this, mystery shopping can be used as an intervention to assess and train pharmacy staff. Objective To determine if repeated student pharmacist mystery shopping with immediate feedback affected the outcome of scenarios requiring referral to a medical practitioner. To determine what, if any, factors may influence whether referral occurred. Setting Thirteen community pharmacies across metropolitan Sydney, Australia. Methods Sixty-one student pharmacist mystery shoppers visited 13 community pharmacies across metropolitan Sydney once weekly over nine weeks between March-October 2015 to conduct audio-recorded mystery shopping visits with assigned scenarios (asthma, dyspepsia, diarrhoea). Students returned to the pharmacy immediately to provide staff members with feedback. Pharmacy staff were scored by mystery shoppers according to a standardised scoresheet. Score data and other characteristics, such as the assigned scenario, were analysed via correlation and logistic regression modelling. Main outcome measure Whether a student mystery shopper was appropriately referred to a medical practitioner based on the presenting symptoms. Results 158 visits were eligible for analysis. Referral to a medical practitioner was appropriately made in 66% of visits. The regression model provided an R2 value of 0.73; the questioning score of the interaction and if a pharmacist was involved in the interaction were significant predictor of appropriate outcome (p < 0.001 and p < 0.01 respectively). Statistically significant differences were found between median questioning and total scores of interactions involving a pharmacist compared to those that did not (p < 0.001). No statistically significant correlation was found between the number of visits and appropriate outcome (p > 0.05). Conclusions Mystery shopping with feedback did not improve pharmacy staff performance over time. Increased questioning and involvement of a pharmacist in the interaction were significant predictors of referral to a medical practitioner occurring.
Collapse
|
48
|
Byrne GA, Wood PJ, Spark MJ. Non-prescription supply of combination analgesics containing codeine in community pharmacy: A simulated patient study. Res Social Adm Pharm 2017; 14:96-105. [PMID: 28283305 DOI: 10.1016/j.sapharm.2017.01.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 12/11/2016] [Accepted: 01/20/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND The inappropriate use of non-prescription combination analgesics containing codeine (NP-CACC) has become a significant health issue in Australia. OBJECTIVE To investigate the current management of NP-CACC direct product requests in community pharmacies located in Victoria, Australia. METHODS A covert simulated patient (SP) method was used to observe the responses of pharmacy staff during an NP-CACC request. Four SPs were trained to complete 1 of 2 scenarios. Each scenario involved a direct product request for Nurofen Plus (200 mg ibuprofen, 12.8 mg codeine) with identical reason for use, symptoms, and medical history but varied previous product use. Scenario One (Sc1) involved a first time NP-CACC user and in Scenario Two (Sc2) the SP had used NP-CACC regularly for the past month. Each visit was documented by the SP immediately after they left the pharmacy. A NP-CACC supply score, created from 4 outcomes (pharmacist involvement, establishment of therapeutic need, establishment of safety and provision of counselling), was given to each pharmacy visit (maximum of 8) during data analysis. RESULTS 145 pharmacy visits were completed. Both scenarios were performed in most of the 75 pharmacies visited (73 Sc1 and 72 Sc2). Treatment was provided in the majority of visits but refused in 37(24%) because the SP was unable to provide photo identification. A pharmacist was involved (directly or indirectly) in 77% of visits. Adequate questioning to establish therapeutic need occurred in 50% of pharmacy visits, safety was established in 17% of visits, and adequate counselling provided in 17% of visits. The SP scenario did not significantly affect the NP-CACC supply outcomes. NP-CACC supply scores ranged from 1 to 8, (Md = 5) with only 1 pharmacy visit achieving the maximum score of 8. CONCLUSIONS The majority of pharmacy visits did not achieve a full score relating to NP-CACC supply, illustrating the need for improved awareness of how to assess and manage patients requesting NP-CACC.
Collapse
Affiliation(s)
- Georgia A Byrne
- Department of Pharmacy and Applied Science, La Trobe Institute for Molecular Science, LaTrobe University Bendigo, Victoria 3550, Australia
| | - Penelope J Wood
- Department of Pharmacy and Applied Science, La Trobe Institute for Molecular Science, LaTrobe University Bendigo, Victoria 3550, Australia
| | - M Joy Spark
- Department of Pharmacy and Applied Science, La Trobe Institute for Molecular Science, LaTrobe University Bendigo, Victoria 3550, Australia.
| |
Collapse
|
49
|
Coulibaly IGS, Morais JCD, Marsiglia RMG, Montanari PM. Doenças sexualmente transmissíveis e a vulnerabilidade da população do Alto Solimões, Amazonas, Brasil. SAUDE E SOCIEDADE 2017. [DOI: 10.1590/s0104-12902017162948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Pessoas que apresentam sintomas de doenças sexualmente transmissíveis na região do Alto Solimões (Amazonas, Brasil), podem procurar farmácias mais próximas de onde residem para tratamento. Este artigo tem por finalidade mostrar como são tratadas e orientadas as pessoas que procuram pelo atendimento em farmácias em vez buscar os serviços de saúde, que são de mais difícil acesso na região. Para tal, realizou-se uma pesquisa de caráter qualitativo e emprego de uma amostra de conveniência. Na pesquisa de campo realizada em três dos nove municípios da região, utilizou-se o “Método do Cliente Misterioso” validado pelo protocolo Situational Analysis of Sexual Health in India (Sashi), desenvolvido pelo London School of Hygiene and Tropical Medicine, já utilizado na Índia, África e no Alto Solimões, seguido de entrevistas semiestruturadas com os mesmos participantes da etapa do cliente misterioso. Observou-se que, quando do uso do Método do Cliente Misterioso, os entrevistados indicaram e venderam antibióticos sem receita médica aos que os procuraram e, quando do uso das entrevistas semiestruturadas, essa prática não foi observada. Em ambas as abordagens, não houve orientação aos clientes sobre os riscos das doenças sexualmente transmissíveis para eles e seus parceiros sexuais. Concluímos com esse estudo que as pessoas que vivem no Alto Solimões estão vulneráveis a essas doenças, sendo necessário que se repense a questão da assistência médica e farmacêutica no âmbito das doenças sexualmente transmissíveis em regiões de difícil acesso do país.
Collapse
|
50
|
Chang J, Ye D, Lv B, Jiang M, Zhu S, Yan K, Tian Y, Fang Y. Sale of antibiotics without a prescription at community pharmacies in urban China: a multicentre cross-sectional survey. J Antimicrob Chemother 2017; 72:1235-1242. [DOI: 10.1093/jac/dkw519] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 11/07/2016] [Indexed: 11/13/2022] Open
|