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Do north-eastern German pharmacies recommend a necessary medical consultation for acute diarrhoea? Magnitude and determinants using a simulated patient approach.

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.

SUBMITTER: Langer B

PROVIDER: S-EPMC7014574 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundPharmacists and pharmacy assistants can support consumers by identifying minor ailments and providing evidence-based advice about treatment options. In the Netherlands, advice is based on national minor ailment guidelines and structured WWHAM questions (Who, What, How long, Action, Medication).ObjectivesTo study whether pharmacy assistants provide guideline-compliant advice for allergic rhinitis based on WWHAM and condition-specific questions (When and Familiarity) and their association with appropriate self-care advice.MethodsA retrospective study of the assessments of simulated patient (SP) visits regarding one condition- and two symptom-based cases of allergic rhinitis in Dutch community pharmacies. Pharmacies that participated in 2014, 2016 and 2018 were selected. SPs documented their observations of the problem analysis, dispensing and client interaction on a standardized scoresheet. Dispensing of an oral antihistamine according to the guideline recommendation was considered as the correct outcome. Chi-square tests were used to analyze differences in scores for problem analysis of pharmacies with correct and incorrect advice provision in 2014 and 2018. Predictors for correct outcome were identified by univariate and multivariate logistic regression analysis.ResultsData from 673 pharmacies were available for all three years. In 2014 and 2018, problems were presented as a symptom (running nose), and 41.2% and 21.1% of pharmacies dispensed an antihistamine. For the condition-based problem (allergy) in 2016, 96.0% of participating pharmacies dispensed an antihistamine. Both in 2014 and 2018, each additional problem analysis question increased the odds ratio of providing correct advice. Questions asked about 'hay fever symptoms', 'medication', 'when symptoms occurred', and 'familiar symptoms' were significant predictors of correct advice provision.ConclusionsMost pharmacies provided appropriate advice for a condition-based request but less than half of them provided appropriate advice for a symptom-based request. More questions asked was associated with an increased chance of providing correct advice. Addition of condition-specific questions may improve the WWHAM-method.

Project description:Background:As antimicrobial resistance became an increasing threat to global public health, Clinical Pharmacist-led Consultation (CPC) for Infectious Diseases (ID) was developed in China. We conducted a survey among hospital pharmacies to investigate the present situation and potential determinants of CPC for ID in China's Guizhou Province. Methods:The study was conducted by sending the questionnaire to the directors of hospital pharmacy who were members of Guizhou Province Pharmaceutical Administration Collaboration Network (GPPACN) from April to May 2019. We implemented the Firth's logistic regression model to analyze the factors that influence the implementation of CPC. The acceptance rate of consultation suggestions (ARCS) and effective response rate after acceptance of pharmacists' suggestions (ERRAPS) were pooled by meta-analysis using a random effect model, respectively. A pairwise meta-analysis was performed to compare the effective response rate between patients whose treatment followed the pharmacists' suggestions and those whose treatment did not. Results:A total of 83 hospitals covering 9 regions in Guizhou Province were included in this survey. The results showed that 50 hospitals (60.24%) developed the CPC for ID. Staffing ID, respiratory, or general clinical pharmacist had a significantly positive effect on the implementation of CPC [adjusted odds ratios = 7.298, 95% CI (confidence interval): 2.232 to 23.858]. The pooled ARCS and ERRAPS for secondary hospitals were 97.59% (95% CI: 94.27 to 100.00%) and 88.36% (95% CI: 84.71 to 92.17%), respectively. Importantly, CPC improved the prognosis of ID patients [risk ratio (RR) = 6.49, 95% CI: 2.84 to 14.82] in these hospitals. Conclusion:CPC adoption is gradually increasing among hospitals and will be a promising intervention for ID treatment at grassroots medical institutions in Guizhou Province. Training more clinical pharmacists to specialize in ID, respiratory, or general diseases might be the most practical measure to promote the development of CPC for ID.

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Do north-eastern German pharmacies recommend a necessary medical consultation for acute diarrhoea? Magnitude and determinants using a simulated patient approach.

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