Background
British government policy has led to an increasing number of medicines being reclassified from Prescription Only Medicines to non-prescription medicines. This has resulted in a wider range of medicines being available for sale to the general public in community pharmacies. Previous research1 indicates that the sale of non-prescription medicines by medicine counter assistants (MCAs) is not always appropriate and does not always comply with Royal Pharmaceutical Society of Great Britain (RSPGB) guidelines2 for the safe and effective supply of medicines to patients. Sub-optimal communication between MCAs and customers has been identified as a major cause of the inappropriate supply of these medicines3. The hypothesis tested by this study is that communication skills training for MCAs will improve their practise, in terms of the supply of NPMs.

Objective
This feasibility study was conducted to develop, deliver and evaluate a communication skills training intervention, aimed at improving information exchange between MCAs and customers during consultations for non-prescription medicines.

Method
MCAs were recruited from community pharmacies in Grampian, Scotland and randomised (using a 2:1 ratio) to either the intervention or control. Up to two MCAs from each pharmacy could participate. The intervention group was invited to attend two communication skills training events. A training package was developed using cognitive behavioural therapy and a mixture of techniques including: didactic sessions; group discussion and role-play (both demonstrated and individual). The effect of the training was assessed using covert, simulated patient visits. Each MCA was scheduled to receive four covert visits (two at baseline, then one after each of the training sessions). The simulated patients wore concealed microphones to record the consultations. Following each visit, the simulated patient also completed a data collection form. The outcome measures that were used to assess the effect of training included: open questions as a proportion of total questions asked; the total number of questions asked; the use of individual WWHAM questions, as well as a Total WWHAM Score; and, compliance with the RPSGB guidelines for the supply of pharmacy medicines.

Results
In total, 93 (89.4%) of the 104 scheduled simulated patient visits were completed. Few consultations involved open questions at any time point and for either group. Preliminary analysis of the results shows that the median total number of questions asked increased at each time point in the intervention group, and remained constant then decreased for the control group. The effect of training appears to have been more pronounced for consultations involving advice requests compared with direct product requests.

Implications for practice
The preliminary results are encouraging as they suggest a general trend within the intervention group towards enhanced communication skills and hence an improvement in information exchange between MCAs and patients. If the overall results of the study confirm this trend, then a large scale randomised controlled study will be conducted of the effectiveness and cost-effectiveness of this intervention. As the number of reclassified medicines increases, MCAs have greater responsibility in ensuring their safe and effective supply. Communication skills training may help them to achieve this goal.

References

1. Watson MC, Bond CM, Grimshaw JM, Mollison J, Ludbrook A, Walker A. Educational Strategies To Promote Evidence-Based Community Pharmacy Practice: A Cluster Randomised Controlled Trial (RCT). Family Practice 2002;19:529-36.
2. Royal Pharmaceutical Society of Great Britain. Medicines, Ethics and Practice. London: RPSGB; 2005. Report No.: 29.
3. Watson MC, Bond CM. The evidence based supply of non-prescription medicines: barriers and beliefs. IJPP 2004;12(June):65-72.