Assessment of Counselling for Acute Diarrhoea in North-Eastern German Pharmacies—A Follow-Up Study Using the Simulated Patient Methodology

Abstract

Aim: As the primary aim of this study, we analysed whether the quality of advice provided by pharmacies in the period between 2014 (baseline study) and 2017 (follow-up study) could actually be increased using a single written performance feedback given to each pharmacy in 2014. The secondary aim of the follow-up examination was to analyse whether the quality of advice differed depending on the professional group providing the advice. Methodology: To ensure the least possible distortion in the comparison between the baseline and the follow-up studies, the study design used for the follow-up examination in 2017 was not changed compared to the baseline examination in 2014. The data for the follow-up examination were therefore collected using the simulated patient method in all 21 pharmacies in a city in the northeast of Germany. Three female and two male test buyers used four different scenarios for self-medication of acute diarrhoea in all of the pharmacies (a total of 84 test purchases). Results: There were significant differences between the overall results from the baseline study (2014) and the follow-up study (2017) (Wilcoxon signed rank test; z = −2.065, p = 0.039, r = 0.225). In the overall average, the pharmacies in 2017 achieved only 2.7 (30%) of 9 possible points whereas in 2014 they achieved 3.3 (37%). The quality of advice between the professional groups did not show any significant differences (Kruskal-Wallis test: χ 2 (2) = 1.946; p = 0.378, r = 0.027). Conclusions: The quality of advice for acute diarrhoea in adults declined over time. A written performance feedback intended to improve the quality proved ineffective. Interventions with a far greater impact are required to achieve an improvement in the quality of advice provided.

The Quality of Counselling for Oral Emergency Contraceptive Pills—A Simulated Patient Study in German Community Pharmacies

“…According to the “Guideline for the use of mystery research in market and social research” [ 71 ], the data collected were anonymised and recorded in such a way that the pharmacies or the personnel involved could not be identified. To avoid a possible Hawthorne effect [ 72 ] and also a possible selection bias [ 73 ], the test purchases were carried out covertly—that is, without informing the pharmacies in advance—analogous to some other national [ 48 , 49 , 50 , 51 ] and international studies [ 21 , 33 , 38 ] and therefore pharmacies were not asked for consent to participate in advance. The lack of informed consent in advance was—analogous to the international literature [ 40 , 74 , 75 ]—resolved in that all pharmacies were informed about the procedure and the background of the study upon completion of the study.…”

“…Unlike the many studies conducted in other countries [ 21 , 23 , 30 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ], in Germany, there have not been any investigations to date on the counselling and dispensing of an emergency contraceptive pill using an SPM approach because the few scientific SP studies available for Germany on the counselling quality in pharmacies are always based on indications other than emergency contraception. Clear deficits in the quality of counselling have been identified in these studies [ 46 , 47 , 48 , 49 , 50 , 51 ].…”

Medication dispensing, additional therapeutic recommendations, and pricing practices for acute diarrhoea by community pharmacies in Germany: a simulated patient study

“…To avoid the Hawthorne effect and to ensure the most realistic possible consultation situation, the test purchases took place without first informing the pharmacies included in the investigation in accordance with other national and international studies 19-21,30-33…”

“…On one hand, according to the guidelines published by the BAK this includes whether relevant questions (for example, how long the symptoms have been present) are asked during the consultation or whether relevant information (for example, regarding the dosage) is provided after dispensing the medication 8. In this regard, the simulated patient (SP) studies available to date for Germany on acute diarrhoea in adults – analogous to the international literature – have identified serious deficiencies 15-21. On the other hand, this also includes the following aspects, which have not yet been investigated in Germany for this indication:…”

What is the attitude towards and the current practice of information exchange during self-medication counselling in German community pharmacies? An assessment through self-report and non-participant observation

“…diarrhoea, headache, heartburn, sedating antihistamines and sleeping pills) have been performed in Germany. These studies suggested an insufficient implementation of the guideline-recommendations in the current counselling practice [36][37][38][39]. Observed routine data on the information exchange through non-participant observation for a wide range of self-medication topics and for consultations with no scripted customers, however, are scarce so far.…”