Objective The aim of this study was to assess progress in patient counselling practices in Finnish community pharmacies during a national four‐year program (TIPPA) from 2000–2003 promoting enhanced pharmacist‐customer communication about medicines. Method A pseudo customer method was applied. Four visits with four different scenarios were conducted in a convenience sample of 60 Finnish community pharmacies of different size and geographic location. In total there were 240 visits during each time point measured (baseline in 2000 and three annual follow‐ups, n = 960). The pseudo customers presented three scenarios related to self‐medication and one related to a prescription medicine with a new prescription (baseline and the second follow‐up) or a repeat prescription of the same medication (the first and the third follow‐up). A structured data form customised to each scenario was used to record the interaction. Key findings Baseline scores were generally low. In two of the four scenarios (one self‐medication and one prescription) a statistically significant improvement (P < 0.05) was found in total scores between the baseline and the third follow‐up. Aggregation of the scores of the three self‐medication scenarios did not show any change in counselling practices between the baseline and the third follow‐up, measured as mean total scores (P = 0.439). Conclusions Some improvements were found in pharmacists' counselling performance in relation to customers' requests for advice about nasal products and also when prescription scenarios were presented. However, pharmacists' counselling rates were low in relation to a repeat prescription or when a request was made to buy a specific medicine. Further attention needs to be paid to the latter two types of consultation.

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Respondents to our survey were supportive of concordance. The TIPPA Project elicited a positive impact on pharmacists' attitudes toward counseling. Pharmacist education through programs such as TIPPA can aid in the implementation of a concordance-based counseling practice.

Background: Pharmacists are expected to develop and re-evaluate their expertise in order to succeed in their working life, thus fulfilling the demands of the society. One of the tasks that has become essential in modern pharmacy practice is "reflective communication about medicines" with patients.Methods: The purpose of this study was to describe the levels of patient counseling skills of 40 Finnish community pharmacists in the context of reflectivity. The theoretical background of the study was based on United States Pharmacopeia (USP) Medication Counseling Stages and Mezirow's theoretical underpinning. The data consisted of essays written by 40 practicing pharmacists (M.Sc. and B.Sc. Pharm.) before starting the one-year patient counseling courses in 2000 ðn ¼ 21Þ and 2001 ðn ¼ 19Þ: The data were analysed using categorization and thematic analysis.Results: The results showed that only one pharmacist reached the level of critical consciousness. Altogether, 22 pharmacists remained at the level of affective reflectivity (the novice level of competency) and 10 remained at the level of consciousness (the beginner level of competency). With the exception of one pharmacist, they had poor understanding of the interactive role of a patient.Conclusion: New teaching methods and evaluation tools applicable to basic education, continuing education and in-house training are needed to support reflective learning process in developing professional competencies, such as patient counseling skills.

The results of this study indicate that even though the USP Guidelines have been promoted strongly through basic and continuing education during the TIPPA Project, more than half of the respondents were not aware of the Guidelines. The Guidelines were considered more useful in learning the principles of patient counselling than learning self-evaluation of performance.