Purchasing restricted medicines in New Zealand pharmacies: results from a "mystery shopper" study

New Zealand has a class of drugs (Restricted Medicines) which are available over the counter in pharmacies, but must be sold by qualified pharmacists. Patient names must be recorded for each sale. Many restricted medicines have recently been reclassified from prescription only, with the expectation that pharmacists provide professional input into their sale. The study described here explored whether pharmacists do fulfill this expectation.

In late 1999, 12 mystery shoppers made 360 visits to 180 pharmacies around New Zealand. Shoppers were of different ages, genders, ethnic and socio-economic backgrounds. Two kinds of products were purchased: diclofenac 25 mg, which was requested for "back pain" and vaginal anti-fungals requested for "thrush".

The main outcome measure described here is whether the shoppers received specified items of counselling. These included questions about the shopper's health status, contraindications to medicine use, advice about the use of the product and the health problem presented. Other outcome measures are whether sales of restricted medicines were carried out by pharmacists or other staff, and whether sales were recorded.

In spite of the requirement that pharmacists sell restricted medicines, shoppers often found it difficult to distinguish pharmacists from other pharmacy staff. Shoppers were able to confirm that a pharmacist was definitely involved in only 46% of visits. In 8.8% of the diclofenac visits, and 10.8% of the visits for vaginal anti-fungals, no counselling was provided. The vaginal anti-fungal visits tended to be more product-focussed than the diclofenac visits. When they purchased diclofenac, most pharmacists asked shoppers if they had, or had had, stomach problems (74.6%) or asthma (65.4%). A minority asked about the symptoms of the vaginal fungal infection which the female shoppers presented with. While most pharmacies recorded patient names, many did so in a way which compromised patient confidentiality.

Pharmacies varied widely in the amount of counselling they provided to people purchasing restricted medicines.