Monitoring quality standards in the provision of nonprescription medicines from Australian Community Pharmacies: results of a national programme

Introduction: Standards of practice have been developed by the pharmacy profession to address the provision of non-prescription medicines, using a consumer-focused and risk management approach. The application of these standards in Australian community pharmacies has been monitored since 2002 by the Quality Care Pharmacy Support Centre (QCPSC). Methods: Between September 2002 and September 2005, 7785 standards maintenance assessment visits were conducted in 4282 pharmacies, using pseudo-patient methodology. 1909 were symptom- based requests (SBRs) and 5876 were direct product-based requests (DPRs), of which 2864 were for pharmacistonly medicines (POMs) and 3012 were for pharmacy medicines (PMs). 2756 pharmacies received two visits, and 747 received three visits. A pharmacy's performance was scored out of 10 at each visit ( scores 0-3: '' unsatisfactory''; 4-6: '' satisfactory''; and 7-10: '' excellent''). Results: There was wide variation in performance at baseline, with 1453 (34%) of pharmacies scoring ( 3, 1851 (43%) scoring 4-6, and 978 (23%) scoring 7-10. Significant improvement was seen over time ( p < 0.001), the mean score increasing by 5% from 4.4 (2.6) at visit 1 to 4.9 ( 2.6) at visit 2, and by 10% to 5.4 ( 2.6) at visit 3. Subanalyses to control for the effect of scenario type and medicine type showed that performance was higher for SBRs than DPRs, but the latter showed greater improvements over time. Conclusion: Repeated pseudo-patient visits lead to notable improvement in behaviour in the handling of nonprescription medicines in community pharmacies. A range of factors need to be considered when measuring these behaviours, such as scenario or medicine type, as they have considerable influence on performance. Future research should focus on issues of quality control, to better understand what makes some pharmacies perform satisfactorily and others unsatisfactorily, and what is required to shift performance from '' satisfactory'' to '' excellent''.