Do north-eastern German pharmacies recommend a necessary medical consultation for acute diarrhoea? Magnitude and determinants using a simulated patient approach

Abstract

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.

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 ].…”

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

“…When comparing our results with an international observation study from Watson et al [ 29 ] the information on ‘who is the patient’ was gathered in our study in less consultations (76% vs. 63%). During simulated patient studies performed in Germany, gathering information on ‘who is the patient’ ranged even between 37% and 92% of the consultations [ 36 , 37 , 39 , 51 ]. The information on ‘symptoms’ was almost similar frequently provided in Watson et al’s study [ 29 ] compared to our study (37% vs. 43%).…”

“…The information on ‘dosage’ ranged in international studies between 16% to 97% [ 52 – 54 ] compared to 33% in our study. In German simulated patient studies, the provision of the parameter ‘dosage’ also differed considerably between the conducted studies (18% vs. 56% vs. 87% vs. 89%) [ 36 , 37 , 39 , 51 ]. This could possibly result from the different underlying simulated case scenarios.…”

“…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 – 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.…”