Impact statements
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Pharmacists should arrange structured training and assessment of knowledge and skills for providing self-care advice for themselves and their team.
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Pharmacists should evaluate the provision of self-care advice in the pharmacy and reciprocal client referrals with general practitioners.
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Pharmacists should raise awareness of the appropriate use of self-care products with their clients.
Introduction
Aim
Ethics approval
Method
Study design and procedure
Topic guide development
Setting
Study participants
Data collection
Data analysis
Results
Number of pharmacies | 13 |
Type of pharmacy | |
Chain | 2 |
Other | 11 |
Location | |
Town < 50,000 inhabitants | 5 |
Town 50,000–100,000 inhabitants | 4 |
City > 500,000 inhabitants | 4 |
Number of prescriptions per day | |
100–200 | 2 |
> 200 | 11 |
Number of OTC* products sold per day | |
< 10 | 1 |
10–50 | 8 |
> 50 | 4 |
Druggist within a distance of 250 m of the pharmacy | 10 |
Supermarket selling OTC* products within 250 m of pharmacy | 9 |
Number of participating community pharmacists | 13 |
Female | 10 |
Position | |
Owner/pharmacist | 3 |
Managing pharmacist | 6 |
Locum pharmacist | 4 |
Years of experience in pharmacy | |
< 5 years | 4 |
5–10 years | 4 |
> 10 years | 5 |
Number of participating pharmacy assistants | 12 |
Female | 12 |
Years of experience in pharmacy | |
< 5 years | 4 |
5–10 years | 3 |
> 10 years | 5 |
Self-care advice in pharmacy practice
PA03: ‘It is my role to advise the patient, help as much as possible and refer the patient to the GP if needed. And, that doesn’t mean that they always leave with a product, but that they anyway know what to do’.
Barriers and facilitators
TDF domain | Barrier | Facilitator |
---|---|---|
Knowledge | Lack of ready knowledge of minor ailments Belief that asking WWHAM questions always leads to correct advice according to the guideline Lack of guideline update communication | Availability of self-care guidelines Accessibility to computerised protocols for minor ailments and pharmacy-only products Assigning CPsa or PAsb responsible for updates and product introductions Regular guideline advice updates Team app for communicating updates and new product introductions or weekly/monthly newsletter Availability of training on self-care guidelines during CPa and PAb education Regular on-the-job training from CPsa (i.e. in work meetings) Availability of web-based training programmes Annual training on seasonal complaints |
Skills | Lack of skills training Lack of skills to retrieve sufficient information from consumers/patients Information about different cultural backgrounds and attitudes towards pharmacists lacking in PAb and CPa education | Optimal conditions for self-care advising, such as personal development plans and team training Presence of conversational (verbal and nonverbal), processing and analytical skills Roleplaying within the team or with trainees Assessing patient self-care skills by web-based testing and simulated patient visits |
Professional role and identity | CPsa underestimating the importance and difficulty of provision of self-care advice | Actively offering advice on self-care and lifestyle CPsa creating optimal pharmacy conditions for self-care advice by PAsb and securing task delegation |
Beliefs about capabilities | Lack of active CPa support for knowledge and skills training | PAs’ intrinsic motivation PAs feeling capable due to available information and support from colleagues and CPsa Awareness of follow-up questions in addition to WWHAM for correct problem analysis and self-care advice Attention to empathic staff attitudes at the counter Realising the limits of one’s knowledge |
Optimism | Lack of recognition of the added value of self-care advice in pharmacy from policymakers and healthcare insurers | Consumers/patients return to the pharmacy for self-care advice based on earlier advice Increase of recognition of self-care advice and the added value of pharmacy by CPsa communicating about minor ailments and self-care online or in journals |
Beliefs about consequences | Compromised medication safety by lack of self-care products registration in electronic patient records Less trust from patients and consumers in information based on guidelines than in information from other sources (e.g. from the internet, advertisement campaigns) Less critical points of sale available (asking fewer questions) for consumers to purchase self-care products | Adding self-care products to electronic patient records enables medication safety monitoring (e.g. interactions, contraindications) Appropriate self-care advice may prevent minor ailments from developing into diseases Lifestyle advice may help to prevent or decrease minor ailment symptoms after stopping self-care medication Appreciating the initiative of the consumer/patient in taking the initiative to research products (e.g. on the internet) improves the attitude of consumers/patients towards advice for a better alternative |
Reinforcement | Self-care product registration in electronic patient records requiring non-reimbursable time Additional workload for self-care advice not covered by margin from generic self-care products Lack of public communication campaign about the added value of self-care advice in pharmacy | CPsa and GPsc working together to measure the added value of self-care advice in the pharmacy by showing decreasing GPc consultations and healthcare costs |
Intentions | Time pressure by prioritising prescription medicines and many patients in the waiting area, leading to assistants paying less attention to problem analysis questioning and registering self-care medicines in the pharmacy information system | Adjusting problem analysis questioning to the consumers depending upon openness to self-care advice Adding self-care products to electronic patient records; at least NSAIDs for patients with cardiovascular disease, elderly patients and home-care patients Providing (lifestyle) advice according to self-care guidelines Registration of pharmacy-only questionnaires in the pharmacy information system |
Goals | Providing easy and timely access to self-care advice in pharmacy Striving for high-quality pharmaceutical care Medication monitoring for patients using chronic medications or having potential contraindications to secure medication safety | |
Memory, attention and decision processes | Asking WWHAM questions without incorporating spontaneous information from consumer/patient Lack of support for correct appraisal of answers to questions | Structured advice according to protocols in self-care guidelines Practising self-care cases in the pharmacy with trainees or team practice during work meetings to iterate knowledge and skills Stickers on pharmacy-only self-care products and products that interact with chronic medications |
Environmental context and resources | Priority for prescription dispensings prohibiting asking out problem analysis questions Priority for prescription dispensings prohibiting self-care product registration in electronic patient records Consumers/patients not open to receiving advice Language problems Patient attitude towards self-care advice, depending on cultural background Consumers/patients with low health literacy level Lack of privacy at the counter Image with GPsc and consumers/patients that products in the pharmacy are more expensive than at the druggist Effort and time needed to build good relationships with GPsc Lack of pharmacotherapeutic meetings with GPsc about minor complaints as main subject | Availability of consultation areas with sufficient privacy (consulting room or privacy counter) Distance between counters and separation between counters to provide more privacy Background music in the waiting area Measuring loudness of assistants’ voices at the counter and listening to consultations at the counter in the waiting area Communicating indirectly about privacy-sensitive issues when privacy is limited Pharmacy team familiar with various languages in areas with patients from different cultural backgrounds Google Translate app or translator by telephone for communicating when language is not spoken in the pharmacy Visual and verbal communication with low-literacy patients Availability of an electronic pharmacy information system to check interactions and contraindications on patient level Organising logistic processes in pharmacy and implementing innovative logistic developments to provide time for self-care advice Agreement with GPsc in pharmacotherapeutic meetings on self-care protocols in the pharmacy and reciprocal referral policy Agreement with GPsc on registering self-care medicines in patient medication records: specifically which products and patients Product prices discussed with GPsc in pharmacotherapeutic meetings, comparing generic and brand products Offering consumers/patients a choice of more and less expensive products with information about effect and prices |
Social influences | Lack of healthcare provider profile of CPsa for consumers/patients | Team members supporting one another in providing self-care advice CPa available for advice on complex situations Spontaneous positive feedback from patients Positive feedback from GPsc after referral |
Emotion | Disappointment when consumers are not open to lifestyle advice | Satisfied customers following up on advice, thus providing positive feelings |
Behavioural regulation | PAsb not accepting responsibility when receiving feedback | Discussing project results (e.g. pharmacy-only product registration) or knowledge/skill test results, including assessing opportunities for improvement CPsa providing feedback to PAs immediately after incorrect self-care advice CPsa encouraging PAsb to share new information with colleagues CPa encouraging new PAs to listen to self-care advice provided by experienced PAs |
Professional role
CP03: ‘Ensuring that your team has enough expertise and skills, so you have to impose requirements on the training programme: partly team training, partly personal training. Facilities and product assortment should be state-of-the-art’.CP01: ‘A pharmacist should monitor and correct PAs’ advice where needed. When pharmacy assistants start working in the pharmacy, their knowledge and skills levels are comparable, but after six months, the influence of the pharmacist shows; but if pharmacists let it slip, then, yes, of course, quality decreases’.
Intentions
CP06: ‘They don’t have time nor feel like answering our questions; they think that pharmacy is always asking questions. They prefer to get it at the druggist or supermarket’.
Knowledge
CP01: ‘We should pay more attention to ready guideline knowledge at the counter’.
CP10: ‘No, I don’t think that WWHAM is always sufficient. We learned that from a simulated patient visit on a symptom-based request in our pharmacy. We did not grasp the catch’.
Skills
CP04:‘Knowledge, of course, relating to the content but also to products, and communication skills, of course, that you are able to ask open-ended questions and follow up on them and the ability to convey it well’.PA03: ‘You have to listen carefully and listen between the lines because they provide a lot of information spontaneously’.PA03: ‘You always keep eye contact, and you explain to the client what you are doing’.CP10: ‘We trained to customise our advice when implementing the Consultation guideline, trying to attune to what people need, and we found it quite hard’.
PA10: ‘We also practice when we discuss a minor ailment during work meetings. We always see to it that we discuss that and update our advice accordingly’.
Beliefs about capabilities
Social influences and beliefs about consequences
Reinforcement
Environmental context
CP06: ‘I never discussed self-care with the GPs, and they may very well not know what we do, but I hope they have any idea of our pharmacy providing self-care advice’.