HSRPP Abstracts: Identifying the barriers to the evidence based supply of nonprescription medicines from community pharmacies: a qualitative study.

Identifying the barriers to the evidence based supply of nonprescription medicines from community pharmacies: a qualitative study.

¹Watson MC, ¹Bond CM, ²Walker AE, ³Grimshaw JM.
¹Department of General Practice and Primary Care (University of Aberdeen, Westburn Road, Aberdeen, AB25 2AY) and ²Health Services Research Unit, University of Aberdeen, ³Ottawa Health Research Institute, Canada. ([email protected])

The reclassification of prescription only medicines (POMs) has major implications for pharmacists and medicine counter assistants (MCAs). The wider range of nonprescription medicines (NPMs) means pharmacy staff (pharmacists and MCAs) are likely to have greater involvement in the promotion of self-care. Evidence based pharmaceutical practice should be the gold standard of care. To achieve this, evidence needs to be synthesised and implemented using strategies that are likely to promote behaviour change. Evidence based guidelines have been effective in improving the quality of health care in other settings. A recent community pharmacy study showed no significant improvement with the appropriateness of sales of NPMs after disseminating evidence based guidelines using different implementation strategies.

The purpose of this study was to explore the use of evidence in the supply of NPMs and the barriers that community pharmacy staff (i.e. pharmacists and MCAs) face when deciding to supply these products. Qualitative methods comprising observation and indepth interviews were used. Only the results of the interviews are presented here.

Nine pharmacies in Grampian, Scotland were selected at random and recruited to the study. Indepth interviews were conducted with a pharmacist and MCA from each pharmacy on a one-to-one basis using a topic guide. The interviews were usually conducted following a minimum of one day's observation. Where possible, the interviews were conducted away from the dispensary and counter area. The interviews lasted up to 90 minutes and were audiotaped and transcribed verbatim. The results were checked for accuracy then entered into NUDIST and coded. Ethical approval was not required.

Interviews were completed with 10 pharmacists (two from one pharmacy were interviewed separately) and eight MCAs. The interviews were conducted between July and October 20002.

A major concern amongst pharmacy staff was the safe supply of NPMs. The interviewees also frequently mentioned concerns regarding inappropriate use in terms of abuse and misuse of NPMs.

Communication between pharmacy staff and customers was often associated with difficulty. Interviewees reported that customers did not always respond well to questioning. MCAs suggested that the public do not distinguish between them and shop assistants in general. There was lack of formal communication between pharmacists and MCAs with regard to agreed procedures for the supply of specific NPMs, or the treatment of particular symptoms or customer groups.

Few interviewees were familiar with the term "evidence based practice". Some pharmacists derived "evidence" from experience. There was considerable variation in attitude towards the role and use of evidence.

The results highlight a need for increased public awareness of MCAs' training and role. There is also scope for increasing awareness amongst pharmacy staff of the importance of evidence based practice in this setting. Many barriers exist to the supply of NPMs from community pharmacies. Interventions need to be designed and evaluated to address these barriers to determine whether behaviour change can be achieved.