Research Method to Evaluate the Quality of Pharmacy Consultation


Ask open-ended questions about the therapeutic purpose of each medication, what the patient expects, and ask the patient to describe or demonstrate how he or she will use the medication.

1.2.6.3. Providing information to patients

Provide verbal information and use visual aids or demonstrations to provide information to patients, supplement with written materials to help patients retain information, demonstrate how to use medication devices such as nasal and oral sprays.

Drug information to be provided to patients:

Drug name: can be the brand name or active ingredient name, or other common name of the drug, can inform the patient about the treatment group or effectiveness of the drug when appropriate.

Indications of the drug or purpose of use of the drug, expected effects of the drug. Includes information such as the drug treats the disease, the drug treats symptoms, the drug stops or slows the progression of the disease, or prevents the disease/symptoms.

When does the medication start working and what to do if it doesn't work?

Information on route of administration, dosage form, dosage and schedule of administration.

Instructions for preparing or administering medication may be adjusted to suit the patient's lifestyle or work environment.

Instructions for handling when patients forget to take medication.

Precautions to be taken during drug administration and risks of the drug relative to benefits. For example, with injectable drugs and drug delivery devices, attention should be paid to the issue of latex allergy.

Serious or common adverse reactions, actions to prevent or minimize them, and how to handle them if they occur.

Technique for self-monitoring drug treatment.

Potential drug-drug, drug-food, and drug-disease interactions, as well as drug contraindications.

Store medicines properly.


Proper disposal of spoiled medications, discontinuation of medications, and use of special dosage forms or medication devices.

Any other information that is personalized to the patient.

1.2.6.4. End of consultation

Review the patient's knowledge of drug use and drug use skills. The patient may be asked to respond to the information provided or to describe how to use the drug. Summarize the information provided, and ask the patient if he or she has any other questions or concerns related to the drug, the disease, or drug treatment [31].

1.3. Current status of drug use consultation

1.3.1. In the world

The current situation of drug use counseling in countries around the world is still not optimistic:

- According to a study in Saudi Arabia (2015) [30], when conducting direct interviews with 350 pharmacies, 66.3% of pharmacies responded that they often advise patients on the purpose of drugs. However, when performing customer role-playing by 4 trained pharmacy students to check the status of counseling at 161 pharmacies, the results were not positive because only 4.6% of pharmacies provided counseling to customers and when asked for counseling, only 43.3% of pharmacies provided counseling in 161 pharmacies.

- In Germany (2003) [34], a role-playing study conducted in 49 pharmacies found that 98% of pharmacies provided advice to customers. However, 36% of pharmacies only provided advice when requested by customers. Similar results were found in other studies in the UK (2017) [56] and in Australia (2007) [53].

1.3.2. In Vietnam

The current situation of drug use counseling in our country is still a worrying issue. According to Smith (2009), pharmacies in developing and underdeveloped countries, including Vietnam, have not yet provided effective drugs and supported customers in using drugs rationally and safely, especially in giving advice [55].


In 2009, author Pham Thanh Phuong [18] used the method of direct observation at pharmacies and acted as a customer to survey the current status of GPP pharmacies in Hanoi, showing that the consultation for patients on drug use was not good, the questions and advice given were not appropriate. Similar results were also found in other studies in Hanoi (2009) [23], and Thanh Hoa (2012) [24].

Not only in terms of consulting skills, pharmacists also lack the necessary professional knowledge in practice. According to a study conducted in 2015 in Da Nang [29], only 5% of pharmacists discussed with patients with diarrhea about signs of dehydration, 2% referred them to medical facilities, and did not provide any advice on prevention; 2% of pharmacists discussed with customers about ADRs of emergency contraceptives and only 7% of them advised customers to use regular contraceptive methods instead. However, this rate improved significantly after they were trained in professional skills and knowledge.

1.4. Research method to evaluate the quality of consultation at pharmacies

The quality of drug consultation at pharmacies is an issue that has received much attention in many countries around the world and in Vietnam. In order to evaluate the quality of consultation provided by pharmacy pharmacists, many studies have been conducted using a variety of research methods.

1.4.1. Interview method

The interview method is a research method that is conducted by interviewing selected subjects, based on a pre-built sample questionnaire or survey form. The interview method allows the researcher to flexibly change the questions to suit the interview subjects while still maintaining the content and purpose of the research. However, this method has the disadvantage of not being able to ensure the honesty of the interview subjects' answers.

Many studies have been conducted using interview methods, with interview subjects being customers [1], [42] or pharmacy staff [1], [11], [15].


1.4.2. Questionnaire survey method

The questionnaire survey method is a method of collecting data based on a questionnaire designed by the researcher and receiving answers from the subjects. To collect accurate information through this method, it is necessary to raise questions and think precisely about the problem to be researched before completing the questionnaire design. At the same time, the questionnaire must be designed so that all subjects understand the same because when investigating, there are no changes or additions as with the interview method. The limitation of this method is that the answers may not be honest because the respondents tend to answer according to the researcher's wishes rather than answering according to reality.

1.4.3. Observation method

Observational method is a method of collecting data by using people or machines to record phenomena and behaviors of research subjects in the research area. Observational method allows to collect more accurate and reliable information than methods that depend on the answers of research subjects (survey method) [41]. Observational method can be classified into interventional observation and non-interventional observation. Most studies conducted in pharmacies are carried out using non-interventional observation method [54]. Observational research has the advantage of maintaining the objectivity of events during the research process, however, the disadvantage of this method is that the observer plays a passive role, has to wait for phenomena to occur, has difficulty in assessing the existence of conditions that give rise to phenomena and events, and therefore is difficult to separate causal relationships.

In Vietnam, there have been many studies conducted using observational methods. These studies are summarized in Table 1.1.

1.4.4. Role-playing method

Role-playing is a research method that is carried out by the role-player (PJ) approaching the research subject and performing a role-play according to a pre-existing scenario. PJ must be trained in the scenario, role-playing skills, and data collection.


through observation and interaction with the research subject. During the role-play, the research subject is not aware of the researcher's activities.

Role-playing was used to assess the quality of pharmacy consultation in a study conducted in Germany [34]. This method has also been used in research to assess the practical skills and knowledge of pharmacy pharmacists, and the effectiveness of educational interventions on OTC drug consultation [32].

Studies conducted using role-playing with various scenarios (purchasing specific drugs, describing illnesses/symptoms, purchasing prescription/non-prescription drugs such as: headache medicine, antacids, ...) showed that the content and form of advice from pharmacists when customers describe illnesses/symptoms are clearly higher than in situations where customers purchase specific drugs [34], [36], [43], [46], [57],.

In Vietnam, role-playing studies have been conducted in many localities across the country (Quang Ninh, Thanh Hoa, Hanoi, Binh Duong, Nghe An, etc.)

A summary of studies assessing the quality of pharmacy consultation is presented in Table 1. 1.


Table 1. 1. Summary table of studies evaluating the quality of consultation at pharmacies in Vietnam

Author, year, location

Method

Research sample

%NBT

no questions asked

%NBT

ask about

historical

use

%NBT

Ask the customer about symptoms

%NBT

no advice

%NBT

advice on dosage, frequency of use

%NBT

advice on when to use

%NBT

ADR Consulting

Nguyen Duc Anh, 2012,

Bar

Chemistry [1]

Observe

150

KH,

30 pharmacies


12.0


-


56.7


46.0


75.3


56.0


2.0

Vu Tuan Cuong, 2010,

Quang Ninh

[10]

Play as KH

30 pharmacies


-


-


-


-


76.8


76.1


15.9

Nguyen Van Phuong, 2013,

Turmeric

An [17]

Observe

177

customer turn,

59 pharmacies


5.0


43.0


69.5


39.8


80.0


41.8


4.5

Maybe you are interested!

Research Method to Evaluate the Quality of Pharmacy Consultation


Tran Thi Phuong, 2016,

Hanoi

[20]

Observe

300

customer turn,

14 sales locations

odd


43.3


41.0


44.7


43.0


45.3


45.7


5.3

Nguyen Minh Tam, 2009,

Hanoi

[23]

Play as KH

30 pharmacies


30.0


60.0


70.0


28.4


62.6


-


6.7

Bui Hong Thuy, 2014,

Bar

Chemistry [24]

Play as KH

-


35.8


6.5


45.5


19.5


60.0


39.0


6.5

Dinh Thu Trang, 2012,

Binh Duong

[27]

Play as KH

50 pharmacies


34.0


-


66.0


24.0


54.0


26.0


-


1.5. Methods to improve the quality of consultation at pharmacies

1.5.1. Immediate response

The immediate feedback intervention involves providing feedback, providing standard information and adjusting the content of drug counseling directly and immediately to the consulting pharmacist. The feedback is provided by the pharmacist educator in a non-confrontational feedback manner. This method was introduced in a 2003 Australian study to improve the quality of OTC drug counseling in pharmacies, and showed that immediate feedback from pharmacist educators to NVNT was effective in changing drug dispensing and drug counseling practices [48]. Direct feedback does not include criticism, the pharmacist educator focuses on commenting on positive aspects while identifying areas for improvement. These feedbacks are given after the NVNT conducts a self-assessment of the quality of his/her counselling, with the aim of increasing the NVNT's confidence in his/her own skills and providing support for improving personal counselling skills and thereby changing practice behaviour [34].

1.5.2. Use of consulting support tools

The tools to support drug consultation for pharmacists in our country are still quite limited. Currently, only the book "Practical Pharmacy Handbook - MIMS Pharmacy Vietnam" is a document used as a tool to serve consultation for many common diseases in pharmacies every day. The advantages of this book: there are diagrams of symptoms, causes, disease progression, treatments, effective drugs, principles of drug sales and advice for pharmacies - patients, ... are all presented in detail, attractive and updated annually according to the latest medical research. However, the disadvantages of MIMS are (1) it mentions many active ingredients that are not available or not popular in Vietnam, (2) the organization of MIMS compilation is sponsored by pharmaceutical companies, so it is inevitable to question the objectivity - unbiasedness in the introduced drugs, (3) there is a lack of consulting information on "folk" treatment methods for common symptoms/diseases. Therefore, the compilation of a tool

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