ObjectivesThe aim of this study was to assess the quality of counselling provided for acute diarrhoea and to evaluate the role of the patient's approach and different user groups in determining the outcome of counselling.MethodsThe simulated patient methodology was used in all 21 community pharmacies in a north‐eastern German city. Four different scenarios related to self‐medication of acute diarrhoea were developed and used in all the pharmacies (a total of 84 visits). The assessment form, completed immediately postvisit by the simulated patient, included 9 objective items scored using dichotomous scales to produce a scale from 0 to 9. After evaluating the data, every pharmacy received individual performance feedback to encourage behavioural changes and improve the quality of the counselling provided.Key findingsOverall, the quality of counselling was poor (mean score of 3.3/9 (37%)). The most common information provided was about dosage (87% of interactions), while the least common information given was about side effects (4% of interactions). The main effect was seen when comparing the product and symptom requests (F(1,60) = 24.748, P < 0.001, ωp 2 = 0.277). There was no effect resulting from different user groups (F(1,28) = 0.237, P = 0.630, ωp 2 = −0.026) and no interaction between the type of request and different user groups (F(1,28) = 3.395, P = 0.076, ωp 2 = 0.073).ConclusionsThis study highlighted the current deficits in appropriate counselling provided by community pharmacies in Germany.

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.

Background:In Germany over-the-counter medications (OTC) – which since 2004 are no longer subject to binding prices – can only be purchased in pharmacies. Pharmacy owners and their staff therefore have a special responsibility when dispensing, advising on and setting the prices of medications.Objective:The aim of this study was to assess medication dispensing, additional therapeutic recommendations and pricing practices for acute diarrhoea in adults and to evaluate the role of the patient’s approach (symptom-based versus medication-based request) in determining the outcome of these aspects.Methods:A cross-sectional study was conducted from 1 May to 31 July 2017 in all 21 community pharmacies in a medium-sized German city. Symptom-based and medication-based scenarios related to self-medication of acute diarrhoea were developed and used by five simulated patients (SPs) in all of the pharmacies (a total of 84 visits). Differentiating between the different test scenarios in terms of the commercial and active ingredient names and also the prices of the medications dispensed, the SPs recorded on collection forms whether the scenario involved generic products or original preparations as well as whether recommendations were made during the test purchases regarding an additional intake of fluids.Results:In each of the 84 test purchases one preparation was dispensed. However, a preparation for oral rehydration was not sold in a single test purchase. On the other hand, in 74/84 (88%) of test purchases, medications with the active ingredient loperamide were dispensed. In only 35/84 (42%) of test purchases, the patient was also recommended to ensure an ‘adequate intake of fluids’ in addition to being dispensed a medication. In symptom-based scenarios significantly more expensive medications were dispensed compared to the medication-based scenarios (Wilcoxon signed rank test: z = -4.784, p < 0.001, r = 0.738). Also within the different scenarios there were enormous price differences identified – for example, in the medication-based scenarios, even for comparable loperamide generics the cheapest preparation cost EUR 1.99 and the most expensive preparation cost EUR 4.53.Conclusions:Oral rehydration was not dispensed and only occasionally was an adequate intake of fluids recommended. There were also enormous price differences both between and within the scenarios investigated.

Background: In Germany, there are two different active substances, levonorgestrel (LNG) and ulipristal acetate (UPA), available as emergency contraception (the “morning after pill”) with UPA still effective even 72 to 120 h after unprotected sexual intercourse, unlike LNG. Emergency contraceptive pills have been available without a medical prescription since March 2015 but are still only dispensed by community pharmacies. The aim of this study was to determine the counselling and dispensing behaviour of pharmacy staff and the factors that may influence this behaviour in a scenario that intends that only the emergency contraceptive pill containing the active substance UPA is dispensed (appropriate outcome). Methods: A cross-sectional study was carried out in the form of a covert simulated patient study in a random sample of community pharmacies stratified by location in the German state of Mecklenburg-Vorpommern and reported in accordance with the STROBE statement. Each pharmacy was visited once at random by one of four trained test buyers. They simulated a product-based request for an emergency contraceptive pill, stating contraceptive failure 3.5 days prior as the reason. The test scenario and the evaluation forms are based on the recommended actions, including the checklist from the Federal Chamber of Pharmacies. Results: All 199 planned pharmacy visits were carried out. The appropriate outcome (dispensing of UPA) was achieved in 78.9% of the test purchases (157/199). A significant correlation was identified between the use of the counselling room and the use of a checklist (p < 0.001). The use of a checklist led to a significantly higher questioning score (p < 0.001). In a multivariate binary logistic regression analysis, a higher questioning score (adjusted odds ratio [AOR] = 1.41; 95% CI = 1.22–1.63; p < 0.001) and a time between 12:01 and 4:00 p.m. (AOR = 2.54; 95% CI = 1.13–5.73; p = 0.024) compared to 8:00 to 12:00 a.m. were significantly associated with achieving the appropriate outcome. Conclusions: In a little over one-fifth of all test purchases, the required dispensing of UPA did not occur. The use of a counselling room and a checklist, the use of a checklist and the questioning score as well as the questioning score and achieving the appropriate outcome are all significantly correlated. A target regulation for the use of a counselling room, an explicit guideline recommendation about the use of a checklist, an obligation for keeping UPA in stock and appropriate mandatory continuing education programmes should be considered.

Background: To determine if pharmacy staff in Germany 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. Moreover, 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 test purchases. Multivariate analysis revealed that a non-pharmacist as opposed to a pharmacist and two or more questions as opposed to no questions were significantly associated with a referral to a doctor. Conclusions: Regarding the necessary referral to a doctor, an enormous potential for improvement was revealed for community pharmacies in the German state of Mecklenburg-Vorpommern. The results should make both the Mecklenburg-Vorpommern pharmacy association and legislators aware of the need to significantly escalate their quality management efforts.