The counter and consultation room work explored in the Netherlands

Three standards were used to compare the Dutch counter work with the international situation. Firstly, the observed 43% of the Dutch care-related conversations at the counter was remarkably similar to the 42% of the customers that received prescribed medicines supported by advice that was derived from the U.K. study [3]. This may be regarded as a good result, even though the communication at the counter is just a part of all communication and must not be overestimated [5‐7]. It is worth mentioning that the observed frequency of 71% at pharmacy 2 is even better and close to the absolute highest reported frequency of 79% in the U.K. study. Secondly, the results of 57% for the Dutch category ‘other conversations’ is much higher than the 28.3% of non health-related communication in the U.K. [3]. Finally, the observed 15% first-time use in the Netherlands is almost the same as the 15.2% of the communication for Rx new in the U.K. [3].

Even though international comparisons are fraught with difficulty, on one hand this may be regarded as a positive result. In an international context Dutch pharmacies do seem to perform rather well. All three pharmacies performed even better than their own staff had expected; they largely underestimated the actual number of care-related counter conversations. On the other hand, it can also be counter-argued that although 43% of the counter work is care-related, 53% of all patients seem to leave the pharmacy without any information and only 0.4% of all counter contacts results in a conversation in the consultation room. Work that was directly related to patient care did not compromise the majority of the work done by the staff. How can this situation be improved?

Firstly, the use of a standard procedure to provide a brief discussion of the patient’s medications appeared to increase the extent to which conversations with significant information content took place at the counter. The situation at pharmacy 2 suggests that the frequency in the provision of information can be improved substantially with standard procedures, in this case for reviewing the dispensed medication briefly. In this procedure all pharmacy staff were obliged (to repeat) explaining the prescription medication and the way of use with the customer at the counter. In this case the brief medication review was performed at 51% of all counter contacts. This procedure at pharmacy 2 led to substantial differences in the observations in the category ‘no information’: 55, 26, and 71% for pharmacies 1, 2, and 3 respectively.

Secondly, the general work study [1] also showed that counter work is only 11% of the total work. With so few opportunities it is clearly important to make the most of the contact with the patient. Raising the awareness of the pharmacy staff of the potential of these moments may help to improve the provision of care still further. The qualified staff should not only ensure that the procedures and facilities of the pharmacy enable the provision of information, such as with a good counter design [30] and a consultation room [8], but also act at the appropriate time to provide care. This may sometimes be very hard to assess. Other patients waiting and listening in with a counter conversation combined with the sensitivity and embarrassment of patients and staff members can seriously hinder a planned change process from solely dispensing to providing pharmaceutical care. Pharmacy staff may need to be trained to be sensitive in such situations and to understand that they can act as a barrier to the provision of pharmaceutical care.

Lastly, the results of the consultation room work comprising 18 observations or 0.6 per working day is half of what was expected from literature. In terms of the quantity of care that can be delivered, counter work would seem to offer many more possibilities and be more likely to repay an investment in staff development than focussing on the consultation room. There is however no evidence either way about the patient’s awareness or lack of, regarding the consultation rooms. It may be as much a matter of the procedures and approach to patient care in which staff has been trained that determines the utilization of these facilities.

A recent Dutch study suggests that pharmacists provide an average of 1.2 consultations in private per working day [8]. In this current study that would correspond with approximately 36.7 consultations. However, the Dutch study was a survey measuring estimated numbers, not actual ones, which may explain the observed differences. The current results have confirmed this assumption. The perceived number of consultations in private was much more positive than reality. A difference of two consultations per day. The measurements in the consultation room showed that only 18 patients were taken apart in 6 weeks at three pharmacies. Most patients may not even know that there is a possibility to have a consultation. It is striking to see that pharmacies 1 and 3 were responsible for all 18 consultations, especially if it is compared with the physical environment. Pharmacy 1 had a real consultation room, pharmacy 3 had a multi-functional room with priority for consultation, and pharmacy 2 only had the regular pharmacist’s office. It suggests that a room or a multi-functional room with strict priority rules for consultation may have positive effects on the number of consultations held. At pharmacy 2 staff members may not have been so comfortable with consultations in the pharmacist’s office. Future research should assess if this suggestion is correct, but also if new interior designs can create the right atmosphere for pharmaceutical care or if new privacy oriented counter designs can make a consultation room redundant. Currently, experiments are taking place in The Netherlands to design and evaluate a counter that also provides privacy to see if it is attractive to patients and staff and if, as a result, more care-related conversations take place [31].

The main limitation is that this is a small quantitative study and that while some speculation about the relationship between the proportion of counter conversations and the utilization of consultation rooms can be done [1], the study raises possibilities that need to be assessed in other studies. There are however some difficulties with the international comparison. Firstly, non-prescription medicines are sold in pharmacies and specialized retail outlets, so-called ‘drogisterijen’, in The Netherlands, which may not be the case in other countries. For instance, in the U.K. these medicines are sold in pharmacies and supermarkets. Secondly, there was no difference made in the data collection among staff with different levels of qualification. Finally, activity in pharmacies may also be affected by the differences in national policies and strategies of the Health Services. Each of these could be expected to alter patient attitudes and behavior towards pharmacies and affect the results and conclusions.