Using a Secret Shopper to Evaluate Pharmacist Provision of Emergency Contraception

Abstract

Introduction:Commonly known as "the morning-after pill," hormonal emergency contraception or the emergency contraceptive pill (ECP) is most effective if used within 72 hours of unprotected sex. In this paper we review a pilot project in Toronto, Ontario, that aimed to increase accessibility by allowing pharmacists to dispense ECP through a pharmacist-physician collaborative agreement, using a predefined protocol. Participating pharmacists received training in the pilot protocol and about ECP.To evaluate whether participating pharmacists were following the project protocol (i.e., giving accurate information to women requesting ECP and dispensing ECP appropriately), and to determine the quality of the pharmacist-patient encounter, we sent "secret shoppers" to participating pharmacies. Using a secret shopper to evaluate pharmacist provision of emergency contraceptionfilled in a questionnaire about the encounter and provided comments. Percentages were calculated for all variables.Results: For Script One encounters (n=17), most pharmacists followed the protocol correctly to dispense ECP. For Script Two encounters (n=17), 71.4% provided alternatives to ECP, but three pharmacists did not follow protocol and provided ECP. For Script One, 52.9% of pharmacists and for Script Two, 71.4%, provided a community referral for follow-up care. The majority of pharmacists (97%) treated the shopper with respect and 85% communicated clearly. Most of the shoppers' comments were positive and the main negative comment about the encounter was lack of privacy. Conclusions:The use of a secret shopper allowed the examination of the pharmacist-customer interaction to delineate issues of importance to the pilot project and provide feedback on areas that may require improvement in the pharmacy provision of emergency contraception, namely, dealing with women who do not qualify for ECP and providing women with community referrals for sexually transmitted infections or ongoing contraception.

A systematic review of the use of simulated patients and pharmacy practice research

“…Thirteen studies were undertaken in Europe, 14,15,17,20,21,24,27,30,37,40,43,49,50 nine in Asia, 7,12,13,22,29,39,42,47,51 eight in South and Central America, 8,9,18,25,31,35,45,48 seven in North America, 23,26,32,34,36,41,46 four in Africa, 13,16,28,33 three in Australasia 10,11,38 and one in the Middle East. 19 The remaining study was conducted across three countries.…”

“…Cohen et al provided a twohour training course which included role playing, familiarisation with emergency contraceptive protocols, and documents that consumers should be given. 23 Lewis et al carried out a four-hour training session, in which simulated patients learned their scripts, completed encounter forms and underwent tests with two investigators. 34 Norris reported carrying out extensive training in role plays and recording information.…”

“…pharmacists, pharmacy staff, drug sellers) were able to opt out of participation, 10,11,14,18,20,26,30,46,50 and in 13 studies, the participants were aware that simulated patients were being used. 10,11,14,15,20,23,26,30,33,38,43,46,50 …”

Use of simulated patients to assess the clinical and communication skills of community pharmacists

“…Cohen et al [19] similarly used two scenarios for their mystery shopper visits to community pharmacies regarding EHC. These two scenarios consisted of one appropriate and one inappropriate, where the episode of unprotected sex occurred greater than 72 h before the pharmacy visit.…”

“…The simulated patient methodology has been used in the USA to assess pharmacists' willingness to obtain (prescription-only) EHC for a customer should they return with a prescription [18]. In Canada, simulated patients were used to assess whether pharmacists participating in a pilot study to allow increased access to EHC from pharmacies were following the project protocol [19]. This study used two scenarios in visits to 17 pharmacies, one where the supply of EHC was appropriate and one where it was inappropriate (greater than 72 h had elapsed since unprotected sexual intercourse).…”