Self-medication consultations in community pharmacy: an exploratory study on teams’ performance, client-reported outcomes and satisfaction
Main Article Content
Nonprescription Drugs, Community Pharmacy Services, Pharmacies, Self Medication, Counseling, Referral and Consultation, Patient Satisfaction, Patient Reported Outcome Measures, Cross-Sectional Studies, Multivariate Analysis, Portugal
Background: Community pharmacy teams (CPTs) have an established role in assisting self-medication, contributing to the safe and effective use of non-prescription medicines.
Objective: The study aimed to describe CPTs’ performance in self-medication consultation, client-reported outcomes, and satisfaction. A secondary purpose was to develop an explanatory model for better understanding clients’ satisfaction with this service.
Methods: Descriptive, cross-sectional exploratory study. Data were collected in a purposive sample of pharmacy clients recruited in six community pharmacies in Portugal. CPTs adopted a structured approach to self-medication consultations, encompassing 11 quality criteria (five for case evaluation and six for counselling). An evaluation score, a counselling score and an overall quality score were estimated. Client-reported outcomes and satisfaction were ascertained via a follow-up telephone interview. Besides descriptive statistics, the association with several independent variables on the clients’ overall satisfaction was explored, using linear regression.
Results: Product-based dispensing was more frequent for lower educated clients. Reported compliance with the criteria by CPTs was overall high (93.95% of maximum compliance), mostly missing the ‘other medication’ questioning. Most clients (93%) reported improvement after the consultation. Clients’ satisfaction score was 4.70 out of 5. The variables that seem to better explain clients’ overall satisfaction are pharmacy loyalty, the evaluation score, and the female gender.
Conclusions: Clients’ reported outcomes were favourable, as well as satisfaction with the service. Clients’ satisfaction appears to be determined by consultation quality (evaluation score), suggesting the advancement of the pharmacists’ clinical role. A larger study is warranted to confirm these findings.
2. van Eikenhorst L, Salema NE, Anderson C. A systematic review in select countries of the role of the pharmacist in consultations and sales of non-prescription medicines in community pharmacy. Res Social Adm Pharm. 2017;13(1):17-38. https://doi.org/10.1016/j.sapharm.2016.02.010
3. Veiga P, Lapão LV, Cavaco AM, Guerreiro MP. Quality supply of nonprescription medicines in Portuguese community pharmacy: An exploratory case study. Res Social Adm Pharm. 2015;11(6):880-890. https://doi.org/10.1016/j.sapharm.2014.12.009
4. Schmiedl S, Rottenkolber M, Hasford J, et al. Self-medication with over-the-counter and prescribed drugs causing adverse-drug-reaction-related hospital admissions: results of a prospective, long-term multi-centre study. Drug Saf. 2014;37(4):225-235. https://doi.org/10.1007/s40264-014-0141-3
5. Cooper RJ. 'I can't be an addict. I am.' Over-the-counter medicine abuse: a qualitative study. BMJ Open. 2013;3(6):e002913. https://doi.org/10.1136/bmjopen-2013-002913
6. Roussin A, Bouyssi A, Pouché L, Pourcel L, Lapeyre-Mestre M. Misuse and dependence on non-prescription codeine analgesics or sedative H1 antihistamines by adults: a cross-sectional investigation in France. PLoS One. 2013;8(10):e76499. https://doi.org/10.1371/journal.pone.0076499
7. Shiffman S, Battista DR, Kelly JP, Malone MK, Weinstein RB, Kaufman DW. Prevalence of exceeding maximum daily dose of paracetamol, and seasonal variations in cold-flu season. Br J Clin Pharmacol. 2018;84(6):1250-1257. https://doi.org/10.1111/bcp.13551
8. Kaufman DW, Kelly JP, Battista DR, Malone MK, Weinstein RB, Shiffman S. Exceeding the daily dosing limit of nonsteroidal anti-inflammatory drugs among ibuprofen users. Pharmacoepidemiol Drug Saf. 2018;27(3):322-331. https://doi.org/10.1002/pds.4391
9. Cooper RJ. Over-the-counter medicine abuse - a review of the literature. J Subst Use. 2013;18(2):82-107. https://doi.org/10.3109/14659891.2011.615002
10. MInistério da Saúde. [Legal status of medications]. https://dre.pt/application/conteudo/540387 (accessed Aug 25, 2020).
11. MInistério da Saúde. [List of health conditions possible be treat by selfmedication]. https://dre.pt/application/conteudo/3189825 (accessed Aug 25, 2020).
12. Nunes de Melo M, Madureira B, Nunes Ferreira AP, Mendes Z, Miranda Ada C, Martins AP. Prevalence of self-medication in rural areas of Portugal. Pharm World Sci. 2006;28(1):19-25. https://doi.org/10.1007/s11096-005-2222-y
13. Martins AP, Miranda Ada C, Mendes Z, Soares MA, Ferreira P, Nogueira A. Self-medication in a Portuguese urban population: a prevalence study. Pharmacoepidemiol Drug Saf. 2002;11(5):409-414. https://doi.org/10.1002/pds.711
14. Ramalhinho I, Cordeiro C, Cavaco A, Cabrita J. Assessing determinants of self-medication with antibiotics among Portuguese people in the Algarve Region. Int J Clin Pharm. 2014;36(5):1039-1047. https://doi.org/10.1007/s11096-014-9992-z
15. Roque F, Soares S, Breitenfeld L, Figueiras A, Herdeiro MT. Influence of community pharmacists׳ attitudes on antibiotic dispensing behavior: a cross-sectional study in Portugal. Clin Ther. 2015;37(1):168-177. https://doi.org/10.1016/j.clinthera.2014.11.006
16. Williams KA, Emmerton LM, Taylor R, Werner J, Benrimoj SI. Non-prescription medicines and Australian community pharmacy interventions: rates and clinical significance. Int J Pharm Pract. 2011;19(3):156-165. https://doi.org/10.1111/j.2042-7174.2010.00091.x
17. Lavallee DC, Chenok KE, Love RM, et al. Incorporating Patient-Reported Outcomes Into Health Care To Engage Patients And Enhance Care. Health Aff (Millwood). 2016;35(4):575-582. https://doi.org/10.1377/hlthaff.2015.1362
18. Veiga P, Lapão LV, Cavaco AM, Guerreiro MP. Tackling the quality of non-prescription medicines dispensing in pharmacies by combining a Balanced Score Card with change management: interim findings. 2016 European Health Management Association Annual Conference. Porto, 14-16 Jun 2016.
19. Peffers K, Tuunanen T, Rothenberger M a, Chatterjee S. A design science research methodology for information systems research. J Manag Inf Syst. 2007;24(3):45-77. https://doi.org/10.2753/MIS0742-1222240302
20. Hevner AR, March ST, Park J, Ram S. Design science in information systems research. MIS Q. 2004;28(1):75-105. https://doi.org/10.2307/25148625
21. Lapão LV, da Silva MM, Gregório J. Implementing an online pharmaceutical service using design science research. BMC Med Inform Decis Mak. 2017;17(1):31. https://doi.org/10.1186/s12911-017-0428-2
22. Bowling A. Mode of questionnaire administration can have serious effects on data quality. J Public Health (Oxf). 2005;27(3):281-291. https://doi.org/10.1093/pubmed/fdi031
23. Armando PD, Martínez Pérez SR, Martí Pallarés M, Solá Uthurry NH, Faus Dáder MJ. Development and validation of a Spanish language patient satisfaction questionnaire with drug dispensing. Pharm World Sci. 2008;30(2):169-174. https://doi.org/10.1007/s11096-007-9158-3
24. Maroco J. Análise estatística com utilização do SPSS. 3 ed. Lisbon: Sílabo; 2007. ISBN: 9789726184522.
25. 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. Int J Pharm Pract. 2018;26(4):310-317. https://doi.org/10.1111/ijpp.12405
26. Benrimoj SI, Werner JB, Raffaele C, Roberts AS, Costa FA. Monitoring quality standards in the provision of non-prescription medicines from Australian Community Pharmacies: results of a national programme. Qual Saf Health Care. 2007;16(5):354-358. https://doi.org/10.1136/qshc.2006.019463
27. Xu T, de Almeida Neto AC, Moles RJ. Simulated caregivers: their feasibility in educating pharmacy staff to manage children's ailments. Int J Clin Pharm. 2012;34(4):587-595. https://doi.org/10.1007/s11096-012-9648-9
28. Sinopoulou V, Gordon M, Rutter P. A systematic review of community pharmacies' staff diagnostic assessment and performance in patient consultations. Res Social Adm Pharm. 2019;15(9):1068-1079. https://doi.org/10.1016/j.sapharm.2018.10.003
29. Carrasco-Garrido P, Jiménez-García R, Barrera VH, Gil de Miguel A. Predictive factors of self-medicated drug use among the Spanish adult population. Pharmacoepidemiol Drug Saf. 2008;17(2):193-199. https://doi.org/10.1002/pds.1455
30. Nunes AP, Costa IM, Costa FA. Determinants of self-medication with NSAIDs in a Portuguese community pharmacy. Pharm Pract (Granada). 2016;14(1):648. https://doi.org/10.18549/pharmpract.2016.01.648
31. Ruiz ME. Risks of self-medication practices. Curr Drug Saf. 2010;5(4):315-323. https://doi.org/10.2174/157488610792245966
32. Limaye D, Limaye V, Krause G, Fortwengel G. A systematic review of the literature to assess self-medication practices. Annals of Medical and Health Sciences Research. Ann Med Health Sci Res. 2017;7:1-15.
33. Raynor DK. Medication literacy is a 2-way street. Mayo Clin Proc. 2008;83(5):520-522. https://doi.org/10.4065/83.5.520
34. Coelho RB, Costa FA. Impact of pharmaceutical counseling in minor health problems in rural Portugal. Pharm Pract (Granada). 2014;12(4):451. https://doi.org/10.4321/s1886-36552014000400002
35. Naik Panvelkar P, Saini B, Armour C. Measurement of patient satisfaction with community pharmacy services: a review. Pharm World Sci. 2009;31(5):525-537. https://doi.org/10.1007/s11096-009-9311-2
36. Policarpo V, Romano S, António JHC, Correia TS, Costa S. A new model for pharmacies? Insights from a quantitative study regarding the public's perceptions. BMC Health Serv Res. 2019;19(1):186. https://doi.org/10.1186/s12913-019-3987-3
37. Melton BL, Lai Z. Review of community pharmacy services: what is being performed, and where are the opportunities for improvement?. Integr Pharm Res Pract. 2017;6:79-89. https://doi.org/10.2147/iprp.s107612
38. Sitzia J, Wood N. Patient satisfaction: a review of issues and concepts. Soc Sci Med. 1997;45(12):1829-1843. https://doi.org/10.1016/s0277-9536(97)00128-7
39. Guerreiro M, Cantrill J, Martins P. Acceptability of community pharmaceutical care in Portugal: a qualitative study. J Health Serv Res Policy. 2010;15(4):215-222. https://doi.org/10.1258/jhsrp.2010.009121
40. 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. 2020;[Ahead of Print]. https://doi.org/10.1016/j.sapharm.2020.09.006
41. Paudyal V, Cunningham S, Gibson Smith K, MacLure K, Ryan C, Cordina M. Methodological considerations in clinical outcomes assessment of pharmacy-based minor ailments management: A systematic review. PLoS One. 2018;13(10):e0205087. https://doi.org/10.1371/journal.pone.0205087
42. Phillips AW, Reddy S, Durning SJ. Improving response rates and evaluating nonresponse bias in surveys: AMEE Guide No 102. Med Teach. 2016;38(3):217-228. https://doi.org/10.3109/0142159x.2015.1105945