Improving Patient-Pharmacist Encounters with Over-The-Counter Medications: A Mixed-Methods Pilot Study

Abstract

Background and Objectives: Over-the-counter (OTC) medication use has increased safety risks for adults older than 65. Most older adults purchase OTC medications from community pharmacies, where the considerable distance or visual obstructions between the prescription area and OTC aisles undermine pharmacists’ ability to assist patients with OTC medication decisions. An innovative redesign of an abbreviated medication section specifically for older adults (called the Senior SectionTM) can facilitate pharmacy staff/patient interaction, potentially improving safe medication selection and use. This study evaluated the impact of the Senior Section on the frequency and content of OTC encounters between pharmacy staff and patients.
 Research Design and Methods: An intervention mixed-methods design generated data from patient OTC encounters, and interviews with two pharmacists and two technicians, throughout the study. NVivo was used to code interview transcripts, and frequencies and chi-square analyses demonstrated pre/post-intervention comparisons for the OTC encounter variables.
 Results: After Senior Section implementation, pharmacy staff were more likely to initiate (and be involved in) patient encounters, address more topics or problem/symptoms, provide details about OTC products, discuss appropriateness of OTC use, and discuss medication classes highlighted in the Senior Section. Pharmacy staff were less likely to need to leave the prescription department for extended periods; they also had fewer prolonged encounters or encounters about product location. Importantly, the Senior Section did not impede pharmacy workflow.
 Discussion and Implications: The Senior Section prompted more frequent, effective, and efficient engagements between pharmacy staff and patients, which may substantially reduce OTC-related harms among older adults.
 
 Article Type: Original Research

Understanding the Factors Influencing Older Adults’ Decision-Making about Their Use of Over-The-Counter Medications—A Scenario-Based Approach

“…Although this analysis is specific to patients' medication use information, the overall study examining Senior Section implementation has so far generated multiple publications describing different aspects and effects of the intervention. These publications have covered such distinct methods or topics as the explanation of the participatory design influence [31], description of the study protocol [32], descriptive analysis of patient/pharmacist encounters defined through a study data collection form, mixed-methods analysis of patient/pharmacist encounters [33], and qualitative assessment of pharmacy staff reactions to the Senior Section [34]. In addition to these publications, manuscripts currently are being prepared to address the following topics:…”

“…Although this analysis is specific to patients’ medication use information, the overall study examining Senior Section implementation has so far generated multiple publications describing different aspects and effects of the intervention. These publications have covered such distinct methods or topics as the explanation of the participatory design influence [ 31 ], description of the study protocol [ 32 ], descriptive analysis of patient/pharmacist encounters defined through a study data collection form, mixed-methods analysis of patient/pharmacist encounters [ 33 ], and qualitative assessment of pharmacy staff reactions to the Senior Section [ 34 ]. In addition to these publications, manuscripts currently are being prepared to address the following topics: a methods paper describing the task simulation and situational interviewing approach used to capture participants’ decisions when selecting and using OTC medications; a methods paper describing the process of classifying types of misuse and operationalizing these misuse constructs; a quantitative analysis of the Senior Section’s effect on the occurrence of standardized medication misuse classifications [ 35 ]; a qualitative analysis classifying types of OTC selection processes for older adults, including the results from a latent semantic analysis of older adults’ interviews; an industrial engineering analytic method to conceptually diagram older adults’ cognitive decision-making process while considering and selecting an OTC medication.…”

Assessing a Medication Safety and Disposal Educational Program using the Health Belief Model

“…This result suggests that providing knowledge development opportunities with effective pharmacist and patient communication has the potential to promote appropriate medication selection, medication utilization, and OTC risk awareness for senior community members. 16 …”

“…This result suggests that providing knowledge development opportunities with effective pharmacist and patient communication has the potential to promote appropriate medication selection, medication utilization, and OTC risk awareness for senior community members. 16 The last domain assessed changes in self-efficacy and cues to action related to the medication safety education. The confidence in community members to seek out medication knowledge from their healthcare provider improved from pre to post-survey, however this was not statistically significant.…”

Impact of a pilot community pharmacy system redesign on reducing over-the-counter medication misuse in older adults

“…However, implementation of the intervention in more and different pharmacies, as well as assessing its impact on a greater number of patients, is warranted before the Senior Section can be considered a translatable and broadly valuable approach. As it now stands, the Senior Section represents a promising approach to enhance patients’ awareness of OTC risks and promote safe use of these medications through timesaving and effective pharmacy staff/patient interactions 28-29 – a method that this research team is committed to continually evaluating and refining to achieve more universal application and sustained positive effect.…”