Evaluation of consultation in community pharmacies with mystery shoppers

Background: Consultation of patients in community pharmacies (CPs) must meet standards, especially in selling over-the-counter drugs; however, there has been no information as to whether northeastern German CPs meet these standards. Objective: To estimate aspects of consultation quality in CPs in Mecklenburg-Vorpommern, located in northeastern Germany, study factors related to consultation quality and check compliance with Pharmacy Practice Law, because not all pharmaceutical professions may legally sell drugs. Methods: In 2005, 6 mystery shoppers (pharmacy students) presented with a headache to 146 of 398 CPs; they requested a sleeping pill plus an antihistaminic drug and completed data collection forms. Consultation scores were calculated and effects of pharmacy/staff characteristics on consultation were modeled with linear (consultation score) and logistic regression (failure to detect a drug-drug interaction). Variables used in models were staff profession, pharmacy size (number of staff), city/town size (number of pharmacies), and day of the week in which shoppers visited the pharmacy. Results: Despite a high willingness of pharmacy staff to provide consultation (83% spontaneously offered advice), northeastern German CPs did not achieve their professional mission. Extreme variation was evident in their questioning of the mystery shoppers regarding use of important single items (from 1% for pregnancy/breast-feeding considerations to 56% for dosing instructions). In all cases, drugs were sold to the shoppers; most (91%) were single agents. Drug-drug interaction detection was low: 43 (30%) counselors informed mystery shoppers about the interaction. The profession of the consulting staff and the size of the pharmacy were associated with consultation quality (highest for pharmacists; lowest for small pharmacies [2-4 staff]). For interaction detection, consulting staff profession was relevant: pharmacists had OR of 3.2 for the detection compared with pharmacy engineers/assistants. In 7 pharmacies, staff illegally sold drugs to customers. Conclusions: Northeastern German CPs have much need and potential for improvement in consultation quality and drug-drug interaction detection. In-depth elicitation of symptoms and details of patients' situations must be improved. Relevant training should be provided, including use of software to identify drug interactions, Mystery shopper studies give valuable information for tailoring training schemes.