Previous research has shown that many consultations that result in the supply of NPMs may not comply with the Royal Pharmaceutical Society of Great Britain (RPSGB) guidelines for the supply of pharmacy medicines. However, it is not known whether medicine counter assistants (MCAs) who are involved with most consultations for these drugs, are aware of these guidelines, nor their attitudes towards them. Furthermore, the mnemonic WWHAM, has previously been promoted as the "guideline" for MCAs to follow during consultations, yet there has been little exploration of their attitudes towards this questioning framework nor the extent of its use in practice. This multi-faceted study explored the knowledge and attitudes of MCAs towards the RPSGB guidelines, as well as their use of WWHAM to collect information to inform their decision to supply NPMs. 

Method 
This study was approved by NHS Grampian Local Research Ethics Committee. The study comprised three components: a non-participant observation study; a self-administered questionnaire; and, semi-structured interviews. Community pharmacies from Grampian, Scotland were invited to participate. All community pharmacies registered with the SPPIRe research network and a 2:1 random sample of non-SPPIRe city: non-city pharmacies were invited to participate. Each MCA who gave signed consent was observed by a non-pharmacist researcher and audiotaped for up to one hour. Each audio-taped consultation will be coded by two independent researchers to determine whether it was compliant with the RPSGB guidelines and WWHAM mnemonic. A semi-structured, post-consultation interview was completed following up to three consultations that occurred during this time. The purpose of each interview was to explore the MCA’s decision-making process during the consultation. The data collected during the interviews will also be used to determine whether the customer was known to the MCA, whether they had previously presented in the pharmacy with a similar product request or condition/symptom presentation, as this information would be relevant to their decision-making process but may not have been apparent to the observer. On completion of the observation period, each MCA was asked to complete a questionnaire that included questions about their confidence in dealing with specific NPMs, their knowledge of and attitudes towards the RPSGB guidelines for the supply of pharmacy medicines, and the mnemonic, WWHAM. Initially, the data from the three study components will be analysed separately and then combined for further analysis and triangulation. 

The majority (83%) of consultations were product requests and most consultations (87%) involved only MCAs. Detailed analysis of the data is underway and will be available for presentation by March 2005.