Background
Methods
Patient simulation
Symptom-based request (ACE inhibitor induced cough)
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Product-based request (ACE inhibitor induced cough)
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Symptom-based request (simple, acute childhood diarrhoea)
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Description of simulated patients
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Group 1: A lay person, female, age 60 and a pharmacist, female, age 31 | Group 1: A lay person, female, age 60 and a pharmacist, female, age 31 | Group 3: A pharmacist, male, age 35 and a pharmacist, female, age 30 |
Group 2: A lay person, male, age 55 and a pharmacist, male, age 25 | Group 2 : A lay person, male, age 55 and a pharmacist, male, age 25 | |
Scenario Description
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On entering the pharmacy, one of the simulated patients said: “What is a good cough medicine that you recommend?” | On entering the pharmacy, one of the simulated patients said: “I want to buy Woods merah
#
” | On entering the pharmacy, one of the simulated patients said: “My child has diarrhoea, what do you recommend?” |
Information provided (only upon questioning): | Information provided (only upon questioning): | |
• The patient is the one who has cough. He/she has been coughing for 4 weeks. The cough is dry, irritating and constant. There are no accompanying symptoms. | • The patient is 4 years old, weight ±20 kg, and height: ±1 m. | |
• The patient tried Bisolvon syrup two weeks ago, but it did not work. | • The patient has acute onset of simple diarrhoea. The diarrhoea started about 6 hours ago. The patient has gone to the toilet three times. The consistency of the stool was mushy, softer than usual. | |
• The patient was diagnosed with hypertension 2 months ago and routinely consumes captopril 25 mg three times a day. | ||
• The patient does not have any medical condition other than hypertension and does not routinely consume any medicines, supplements, or herbal medicines other than captopril. | • The patient is generally well, still can play around. Patient is not restless, not irritable, not lethargic, and still has normal drinking habit. The patient has no accompanying symptoms and has not taken any medicines for diarrhoea. The patient has no other medical conditions and does not routinely take any other medications, supplements or herbal medicines. The patient does not have any allergies. | |
• The patient does not smoke and is not a passive smoker. The patient exercises regularly and follows a healthy diet. | • The patient does not eat anything unusual and no other family members have diarrhoea. | |
• The blood pressure is controlled (~130/80) and the patient does not have any allergies. |
Pharmacy staff interviews
Interviews with pharmacy managers
Interviews with eligible pharmacy staff
The types of information gathered
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Total number of interviewees that reported gathering the types of information as “often” or “always” (n = 173)
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Number of interviewees that reported gathering the types of information as “often” or “always” by the professional background
| |||
---|---|---|---|---|---|
Pharmacists (n = 42)
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Pharmacy technicians (n = 32)
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Staff without formal education in pharmacy (n = 99)
| |||
Patient identity | 159 (92%) | 41 (98%) | 26 (81%) | 92 (93%) | |
Signs and symptoms | |||||
• Nature of symptoms | 164 (95%) | 42 (100%) | 30 (94%) | 92 (93%) | |
• Duration of symptoms | 101 (58%) | 31 (74%) | 15(47%) | 55(56%) | |
• Precipitating factors | 38 (22%) | 15 (36%) | 11(33%) | 12 (12%) | |
• History of the symptoms | 30 (17%) | 15 (36%) | 4 (13%) | 11 (11%) | |
• Accompanying symptoms | 162 (94%) | 39 (93%) | 30 (94%) | 93 (94%) | |
• Danger symptoms* | 44 (25%) | 16 (28%) | 12 (38%) | 16 (16%) | |
Action taken | 120 (69%) | 37 (88%) | 23 (72%) | 60 (61%) | |
Medical history | 34 (20%) | 11 (26%) | 8 (25%) | 15 (15%) | |
Current medications being used | 45 (26%) | 15 (36%) | 7 (22%) | 23 (23%) | |
Allergies | 53 (31%) | 13 (31%) | 12 (38%) | 28 (28%) |
Data analysis for factors associated with the reported amount of information gathered
Results
Study participants
Patient simulation method
Pharmacy manager interviews
Pharmacy staff interviews
The reliability results
Pharmacy characteristics
Pharmacy characteristics
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n = 69 (%)
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Pharmacy type | |
• Attached to doctor’s clinic | 50 (72%) |
• Not attached to doctor’s clinic | 19 (28%) |
Pharmacy location | |
• Street | 62 (90%) |
• Residential areas | 3 (4%) |
• Traditional market | 3 (4%) |
• Shopping mall | 1 (1%) |
Pharmacy ownership | |
• Pharmacist | 7 (10%) |
• Non-pharmacist | 60 (87%) |
• Other (i.e., joint business of pharmacist and non-pharmacist) | 2 (3%) |
Pharmacy services | |
• Self-medication services | 69 (100%) |
• Compounding prescription medication services | 65 (94%) |
• Non-compounding prescription medication services | 68 (99%) |
• Other (e.g., health promotion, etc.) | 2 (3%) |
Estimated total patients served per day (from 67 pharmacies)* | 4595 |
Estimated total patients served for self-medication per day (from 67 pharmacies)* | 2975 |
Total staff employed in the 69 pharmacies surveyed | 352 |
• Total number of pharmacists | 75 |
• Total number of pharmacy technicians | 86 |
• Total number of staff who do not have formal education in pharmacy | 191 |
Total staff working hours per week in the 69 pharmacies surveyed | |
• Pharmacists | 1270 |
• Pharmacy technicians | 3542 |
• Other staff who do not have formal education in pharmacy | 8973 |
Total pharmacy opening hours per week in the 69 pharmacies surveyed | 6198 |
Number of pharmacies which had a ratio of pharmacists’ working hours per week to total pharmacy opening hours as <1** | 68 (99%) |
Number of pharmacies which had a ratio of pharmacy technicians’ working hours per week to total pharmacy opening hours as <1** | 52 (75%) |
Number of pharmacies in which the pharmacist manager had a primary job other than being a pharmacy manager (i.e., as a government employee) | 55 (80%) |
Pharmacy staff characteristics
Pharmacy staff characteristics
|
n = 173 (%)
|
---|---|
Professional background | |
• Pharmacists$ | 42 (24%) |
• Pharmacy technician* | 32 (19%) |
• Staff without formal educational background in pharmacy | 99 (57%) |
Age (years; mean ± SD) | 30 ± 7.8 |
Gender : female | 140 (81%) |
Highest education qualification | |
• Pharmacist registration training program | 42 (24%) |
• Bachelor degree in pharmacy | 2 (1%) |
• Three year diploma in pharmacy | 21 (12%) |
• Pharmacy assistant school equivalent to senior high school | 9 (5%) |
• Senior high school | 79 (46%) |
• Others (i.e., bachelor degree or diploma in subjects other than pharmacy) | 20 (12%) |
Working experience (years; median, IQR#) | 3, IQR = 1.5 – 7 |
Ever attended training on self-medication after graduation from the highest education qualification | |
• Yes | 19 (11%) |
• No | 154 (89%) |
The types of information gathered
Patient simulation results
The types of information gathered
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Symptom-based requests (ACE inhibitor induced cough) n = 76 pharmacies
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Product-based request (ACE inhibitor induced cough) n = 69 pharmacies
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Symptom-based request (Simple, acute childhood diarrhoea) n = 80 pharmacies
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---|---|---|---|
• Patient identity | 23 (30%) | 2 (3%) | 77 (96%) |
• Signs and symptoms, This included: | |||
o Nature of symptoms (i.e., whether the cough productive or non productive in the 2 cough scenarios; and stool consistency and frequency of diarrhoea in the childhood diarrhoea scenario). | 67 (88%) | 4 (6%) | 22 (28%) |
o Duration of symptoms | 16 (21%) | 0 (0%) | 27 (34%) |
o History of symptoms | 3 (4%) | 0 (0%) | 0 (0%) |
o Precipitating factors | 0 (0%) | 0 (0%) | 4 (5%) |
o Accompanying symptoms | 28 (37%) | 0 (0%) | 12 (15%) |
o Danger symptoms* | 0 (0%) | 0 (0%) | 0 (0%) |
• Action taken | 12 (16%) | 0 (0%) | 5 (6%) |
• Medical history | 3 (4%) | 0 (0%) | 0 (0%) |
• Current medications being used | 0 (0%) | 0 (0%) | 0 (0%) |
• Allergies | 0 (0%) | 0 (0%) | 0 (0%) |
Pharmacy staff interview results
The amount of information gathered
Patient simulation results
Pharmacy staff interview results
Factors associated with the amount of information gathered
Factors
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Univariable analysis
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Multivariable analysis*
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---|---|---|---|---|
OR (95% CI)
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P value
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OR (95% CI)
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P value
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Professional background | ||||
• Pharmacist |
3.0 (1.64 – 5.42)
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<0.001
|
2.4 (1.29 – 5.44)
|
0.006
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• Pharmacy technician |
2.6 (1.06 – 6.35)
|
0.038
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3.0 (1.10 – 8.00)
|
0.031
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• Staff without formal education in pharmacy | Reference | Reference | ||
Age | ||||
• <30 years old | 1.3 (0.74-2.26) | 0.370 |
2.4 (1.21 – 4.65)
|
0.012
|
• ≥30 years old | Reference | Reference | ||
Gender | ||||
• Male | 0.99 (0.50 – 1.98) | 0.984 | ||
• Female | Reference | |||
Working experience | ||||
• ≤3 years |
0.4 (0.23-0.75)
|
0.004
|
0.3 (0.14 – 0.50)
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<0.001
|
• >3 years | Reference | Reference | ||
Post-graduation training in self-medication | ||||
• Yes | 2.2 (0.84 – 5.75) | 0.109 | ||
• No | Reference | |||
Type of pharmacy | ||||
• Attached to doctors’ clinic | 2.0 (0.99 – 4.03) | 0.055 | ||
• Not attached to doctors’ clinic | Reference | |||
Total number of patients served per day. | 1.0 (0.99, 1.01) | 0.867 | ||
Total number of patients requesting self-medication served per day. | 1.0 (0.99, 1.01) | 0.893 | ||
Total pharmacists’ working hours per week. |
1.02 (1.01 – 1.03)
|
0.005
|
1.02 (1.00 – 1.03)
|
0.011
|
Total pharmacy technicians’ working hours per week. | 1.0 (0.99 – 1.01) | 0.999 |