Non-prescription supply of combination analgesics containing codeine in community pharmacy: A simulated patient study.

Abstract

The inappropriate use of non-prescription combination analgesics containing codeine (NP-CACC) has become a significant health issue in Australia. To investigate the current management of NP-CACC direct product requests in community pharmacies located in Victoria, Australia. A covert simulated patient (SP) method was used to observe the responses of pharmacy staff during an NP-CACC request. Four SPs were trained to complete 1 of 2 scenarios. Each scenario involved a direct product request for Nurofen Plus (200mg ibuprofen, 12.8mg codeine) with identical reason for use, symptoms, and medical history but varied previous product use. Scenario One (Sc1) involved a first time NP-CACC user and in Scenario Two (Sc2) the SP had used NP-CACC regularly for the past month. Each visit was documented by the SP immediately after they left the pharmacy. A NP-CACC supply score, created from 4 outcomes (pharmacist involvement, establishment of therapeutic need, establishment of safety and provision of counselling), was given to each pharmacy visit (maximum of 8) during data analysis. 145 pharmacy visits were completed. Both scenarios were performed in most of the 75 pharmacies visited (73 Sc1 and 72 Sc2). Treatment was provided in the majority of visits but refused in 37(24%) because the SP was unable to provide photo identification. A pharmacist was involved (directly or indirectly) in 77% of visits. Adequate questioning to establish therapeutic need occurred in 50% of pharmacy visits, safety was established in 17% of visits, and adequate counselling provided in 17% of visits. The SP scenario did not significantly affect the NP-CACC supply outcomes. NP-CACC supply scores ranged from 1 to 8, (Md=5) with only 1 pharmacy visit achieving the maximum score of 8. The majority of pharmacy visits did not achieve a full score relating to NP-CACC supply, illustrating the need for improved awareness of how to assess and manage patients requesting NP-CACC.