A qualitative non-participant observational study of non-prescription counseling in community pharmacies

The global rise in self-care and non-prescription product sales allows more people to self-treat minor ailments, and pharmacies have a key role in guiding this use. However, discrepancies between counseling standards and practice suggest a gap in ensuring safe and informed self-medication, necessitating exploration and understanding.

This study investigates counseling on all non-prescription products in pharmacies, with the following objectives: 1) assess compliance with The Norwegian OTC Counseling Standard (the Standard), 2) identify factors predicting standard compliance, and 3) describe the content of non-prescription counseling.

A non-participant observation study (n = 275) was conducted in the self-care section of Norwegian pharmacies (n = 7) from September 2022 to March 2023. During the encounters, 494 products were purchased. Notes from the observations were transformed into transcripts. The transcripts were analyzed using Content Analysis, where codes were quantified and compiled into a spreadsheet. Statistical analysis was performed using Chi-square tests and Logistic regression to evaluate standard compliance and predictive factors.

Full compliance with the standard was 14.6 %; however, ∼40 % of product inquiries did not meet the requirements. Busier pharmacies showed higher standard compliance compared to quieter, and counseling starting at the shelves was more comprehensive. Moreover, pharmacists were likelier than pharmacy technicians to provide information about OTC products (p-value = 0.01). Standard compliance was higher for other non-prescription products than for OTC products. Assessment of the customer's product needs typically revolved around previous use, the intended user, and symptoms, with less emphasis on patient-specific factors (e.g., contraindications, interactions). Information was usually practical, for example, instructions on use and dosage, while discussions on effects and adverse drug reactions depended on customer prompts.

The study found infrequent compliance with the standard, with information often being generic and not tailored to customer needs. OTCs have lower standard compliance than other products sold in pharmacies. Further efforts need to be made to improve counseling, including revising the standard focusing on communication skill promotion and expanding to consider all health-related products in the self-care section. This could improve self-treatment and reduce the burden on other healthcare providers.