Assessment of pharmacist’s recommendation of non-prescription medicines in Brazil: a simulated patient study

Background The number of medicines available without a prescription has increased in Brazil as elsewhere. The Brazilian National Health Surveillance Agency recently passed a resolution emphasizing the role of Brazilian pharmacists in promoting rational use of medicines. However, evidence that Brazilian pharmacists monitor the use of non-prescription medicines in the community promoting rational use of medicines is lacking. Objective To assess practice behavior of pharmacists in Brazil when providing nonprescription medicines in the community pharmacy setting. Setting The study was conducted in 25 community pharmacies from a city of Aracaju in Brazil. Methods Simulated patients visited a convenience sample of 25 pharmacies twice from March to July 2010. During the visits, simulated patients enacted two standardized scenarios: treatment for a persistent headache and childhood diarrhea accompanied by fever. The interactions with the pharmacists were audiovisually recorded using a hidden micro camera. Recordings were later used to fill out a questionnaire designed to evaluate practice behavior of community pharmacists. Main outcome measure The communication and counseling skills of pharmacists in the recommendation of non-prescription medicines, aiming at the rational use of medicines. Results Pharmacists in the study spent on average 1.5 min counseling the simulated patient. At least one question was asked to assess signs and symptoms in 50.0 % of the simulated patient visits in the headache scenario and in 56.0 % of visits in the childhood diarrhea scenario. Non-pharmacological treatment was suggested in 25 % of visits in the childhood diarrhea scenario. During the counseling process, no pharmacist advised the simulated patient about possible drug interactions, adverse reactions and what to do if the patient forgot to take the medicine. The pharmacists had low scores in measures of non-verbal communication. The sample of this study presented poor communication skills, compromising the treatment of the patients. Conclusion This study showed that the pharmacists’ counseling in the simulated patient assessment was insufficient, indicating a need for substantial improvement in practice behavior.