Mystery Shopper Study Research Articles

Assessing Access to Trauma-Informed Outpatient Mental Health Services for Adolescents: A Mystery Shopper Study.

The authors aimed to examine how access to trauma-informed mental health services in safety-net health centers varies by insurance type and race-ethnicity of the care seeker. In this mystery shopper study, three women (White, Latina, and Black voice actresses) called community mental health centers (CMHCs) and federally qualified health centers (FQHCs) (N=229) in Cook County, Illinois, posing as mothers requesting a mental health appointment for their traumatized adolescent child. Each health center was called twice-once in the spring and once in the summer of 2021-with alternating insurance types reported (Medicaid or private insurance). Ability to schedule an appointment, barriers to access, wait times, and availability of trauma-specific treatment were assessed. Callers could schedule an appointment in only 17% (N=78 of 451) of contacts. Reasons for appointment denial varied by organization type: the primary reasons for denial were capacity constraints (67%) at CMHCs and administrative requirements to switch to in-network primary care providers (62%) at FQHCs. Insurance and organization type did not predict successful appointment scheduling. Non-White callers were significantly less likely (incidence rate ratio=1.18) to be offered an appointment than the White caller (p=0.019). The average wait time was 12 days; CMHCs had significantly shorter wait times than FQHCs (p=0.019). Only 38% of schedulers reported that their health center offered trauma-informed therapy. Fewer than one in five contacts resulted in a mental health appointment, and an apparent bias against non-White callers raises concern that racial discrimination may occur during scheduling. For equitable access to care, antidiscrimination policies should be implemented.

Mystery Shopper Study of State Medicaid Coverage for Out-of-State Abortion Care

This cross-sectional study uses a mystery shopper survey to examine variation in state Medicaid agency responses to coverage questions on out-of-state abortion care.

Cannabis Retailer Communication About Cannabis Products, Health Benefits, and Risks: A Mystery Shopper Study of Licensed Retailers in Five U.S. Cities.

As the U.S. cannabis market expands, surveillance of retailer practices, especially product health claims and risks, is crucial to protect consumers. In this study, mystery shoppers (i.e., staff not explicitly identified as researchers) examined retail personnel communication regarding product recommendations, health benefits, safety, and/or risks among U.S. cannabis retailers. In Summer 2022, mystery shoppers audited 140 licensed cannabis retailers in 5 cities in states with established nonmedical (i.e., recreational) cannabis sales and diverse regulations (Denver, Colorado; Seattle, Washington; Portland, Oregon; Las Vegas, Nevada; Los Angeles, California). Descriptive and bivariate analyses characterized retail personnel communication overall and across cities. Common product recommendations for new users included edibles, pre-rolled joints, and bud/flower, and 8.6% offered free/inexpensive ways to sample products. Although Colorado, Washington, and Oregon explicitly prohibited health claims in advertising or labels, more than 90% of retailers there endorsed use for anxiety, insomnia, and/or pain. Whereas 54.3% endorsed use for pregnancy-related nausea (least common in Denver, 23.3%; most common in Seattle, 76.7%), 26.4% warned against use during pregnancy (most frequently in Denver, 46.7%; least frequently in Seattle and Portland, 13.3%). Overall, 52.1% warned against driving after use (most frequently in Denver, 80.0%; least frequently in Las Vegas, 20.0%). Almost all (≥90%) sold cannabidiol (CBD) products and endorsed their health benefits and safety, but few (<10%) sold or endorsed delta-8 tetrahydrocannabinol (THC), etc. (all of which were in Los Angeles). Ongoing cannabis retail surveillance, particularly using protocols assessing factors outside those visibly observable, is needed to inform regulatory and enforcement efforts, especially related to health claims.

Low availability, long wait times, and high geographic disparity of psychiatric outpatient care in the US

ObjectiveTo identify potential barriers to care, this study examined the general psychiatry outpatient new appointment availability in the US, including in-person and telepsychiatry appointments, comparing results between insurance types (Medicaid vs. private insurance), states, and urbanization levels. MethodThis mystery shopper study investigated 5 US states selected according to Mental Health America Adult Ranking and geography to represent the US mental health care system. Clinics across five selected states were stratified sampled by county urbanization levels. Calls were made during 05/2022–07/2022. Collected data included contact information accuracy, appointment availability, wait time (days), and related information. ResultsAltogether, 948 psychiatrists were sampled in New York, California, North Dakota, Virginia, and Wyoming. Overall contact information accuracy averaged 85.3%. Altogether, 18.5% of psychiatrists were available to see new patients with a significantly longer wait time for in-person than telepsychiatry appointments (median = 67.0 days vs median = 43.0 days, p < 0.01). The most frequent reason for unavailability was provider not taking new patients (53.9%). Mental health resources were unevenly distributed, favoring urban areas. ConclusionPsychiatric care has been severely restricted in the US with low accessibility and long wait times. Transitioning to telepsychiatry represents a potential solution for rural disparities in access.

“My implant is expiring”: A national US mystery shopper study regarding extended use of the contraceptive implant

ObjectivesTo assess if patients can access extended use of the contraceptive implant when they call to schedule a removal or replacement. Study designWe conducted a national secret-shopper study of reproductive clinics with a standardized script. Purposeful sampling provided geographic and practice type diversity. ResultsOf 59 clinics sampled, the majority (n=40, 67.8%) recommended replacement at three years or could not provide information regarding extended use by phone, and 19 (32.2%) offered extended use. Offering extended use varied by clinic type. ConclusionsPatients calling to schedule a removal or replacement of the implant often do not receive information regarding extended use beyond three years.

The Quality of Advice Provided by Pharmacists to Patients Taking Direct Oral Anticoagulants: A Mystery Shopper Study

Pharmacists report being less confident in their knowledge of direct acting oral anticoagulants (DOACs) than of vitamin K antagonists, which may influence their ability to detect and manage complications arising from DOAC use. In a mystery shopper study, patient agents were sent into community pharmacies with symptom or product-related requests related to common complications that might arise during treatment with oral anticoagulants, with each visit being assessed for the preferred outcome. Only 10/41 (24.4%) visits resulted in the preferred outcome. A complete history-taking process, obtaining a medical history, patient characteristics and pharmacist involvement were strong predictors of the preferred outcome being achieved. The preferred outcome was not consistently achieved without pharmacist involvement. The potential for strategies that support comprehensive pharmacist involvement in over-the-counter requests should be considered to ensure the provision of optimal care to patients taking high-risk medications such as DOACs.

Evaluation of Patient Assessment and Counseling of Over-the-counter Oral Contraceptives by Community Pharmacists in South Korea: A Mystery Shopper Study

Evaluation of Patient Assessment and Counseling of Over-the-counter Oral Contraceptives by Community Pharmacists in South Korea: A Mystery Shopper Study

Emergency contraception from the pharmacy 20 years on: a mystery shopper study

BackgroundEmergency contraception (EC) was approved in the UK as a pharmacy medicine for purchase without prescription in 2001. Twenty years later we conducted a study to characterise routine practice pharmacy...

A mystery shopper study identifying practice-level barriers to adolescent IUD access in western Pennsylvania

Objective(s)To identify practice-level barriers that adolescents experience when seeking a hormonal intrauterine device (IUD). Study designWe secret-shopped gynecological practices within a health system using a script targeting potential practice-level barriers. ResultsWe assessed 50 of a targeted 50 practices; only 8 (16%) would schedule a contraceptive appointment that permitted same-day IUD placement. Twenty-eight (56%) respondents stateda parent must accompany the adolescent. ConclusionPractice-level barriers toadolescentIUD access exist that are inconsistent with best-practice guidelines and Pennsylvania state law. ImplicationsPractice staff and providers need more medical and legal education regarding IUD provision to adolescents.

Pharmacists' clinical competency towards oral mucosal diseases: Results from a mystery shopper study.

To investigate the clinical advices pharmacists would give to patients who present with various oral mucosal lesions. One hundred and twenty pharmacists in three major cities in the United Arab Emirates (UAE) were approached by senior dental students acting as mystery shoppers. Pharmacists were shown an image of one of four oral mucosal lesions representing candidosis, aphthous ulcer, erosive lichen planus and squamous cell carcinoma (SCC). Pharmacists' referral pattern and choices of medications were recorded and assessed against demographic variables. Eighty-eight per cent (88%) of pharmacists dispensed a non-prescription medication to treat the oral lesions, including SCC, while only 12% recommended that the lesion shown to them be assessed by a clinician. Among all referral recommendations, 32% were for SCC (p=.006). Geographical proximity of a clinic to the pharmacy was a significant factor in determining pharmacists' referral recommendation (p=.036). Most pharmacists dispensed a medication for oral mucosal lesions, including potentially malignant and malignant ones, without referring patients to a medical or dental practitioner. Pharmacists should be aware of the serious nature of some oral mucosal lesions and the necessity to refer those cases to a qualified practitioner for proper clinical assessment.

Understanding the United Kingdom marine aquarium trade - a mystery shopper study of species on sale.

In this study, we conducted a unique survey of marine ornamental fishes appearing in UK retail stores, as well as a review of government trade statistics, with the aim to significantly strengthen the evidence-base in support of future management initiatives. Fifty marine aquarium retailers were visited. A total of 380 marine aquarium fish species (4926 individuals), from 48 families were recorded with the largest proportion of individuals belonging to the families Pomacentridae, Acanthuridae, Apogonidae, Labridae, Pomacanthidae, Gobiidae and Labridae. The majority of fishes for sale (91% of species) originated from the Indo-Pacific Ocean, with only a small number (9% of species) derived from the Atlantic Ocean. However, exact sources of individual species were unclear and poorly documented. Government trade statistics revealed that the ornamental reef-fish trade in the UK grew markedly between 1996 and 2008 with a rapid acceleration in 2003-2004. However, imports have declined since 2008 and amounted to less than 305,000 kg in 2017 with an economic value of UK £3 million (c. US $3.8). Recent trade data (2017) identify Indonesia, USA, Philippines and the Maldives as the most important countries in terms of imports to the UK. The UK is an important exporter of wild-caught fishes via trans-shipment, but also production of tank-reared animals. Several species observed for sale in the UK have been designated by the IUCN and CITES as being of conservation concern, although all these animals are thought to have been captive-reared.

Access to Developmental Pediatrics Evaluations for At-Risk Children.

To determine a national average wait time for developmental pediatric evaluations and to understand differences in access based on whether an appointment is requested by an English or Spanish-speaking caller. We conducted a mystery shopper study in which a bilingual research assistant called developmental pediatrics programs affiliated with US children's hospitals listed on a public directory requesting an appointment for his simulated child experiencing a developmental problem. If an appointment was not provided, a wait time estimate was requested. Programs that provided an estimate in English were called within 24 hours using a translated script. We excluded programs that did not include a developmental pediatrician, only accepted referrals from within their health system or plan, focused on specific disorders, or did not conduct initial evaluations. Of 244 hospitals listed, 140 unique programs were identified and called in English. One hundred four programs were reached. Ninety programs met inclusion criteria, 75 provided an estimated wait time. The mean estimate was 5.4 months (standard deviation: 4.5). Among these 75 programs, 62 were reached in Spanish but only 55% provided a wait time estimate; 31% did not provide language accommodations. The difference between average estimates obtained in English and Spanish was not statistically significant. Among a national sample of US children's hospitals, we identified barriers to evaluations conducted by developmental pediatricians including long wait times and inadequate Spanish language accommodations at some programs. More work is needed to identify optimal strategies to connect children with developmental concerns to evaluations when necessary.

Taking a Page from Retail: Secret Shopping for Academic Libraries

Abstract&#x0D; &#x0D; Objective – The University Libraries at the University of North Carolina at Greensboro (UNCG) sought to gain feedback on the customer service experience beyond satisfaction surveys. After reviewing a variety of methods, it was determined to conduct a mystery or secret shopper exercise, a standard practice in the retail and hospitality world. &#x0D; &#x0D; Methods – Two mystery shopper assessments were conducted in 2010 and 2012. Students were recruited from a Hospitality Management class to serve as the secret shoppers. “Shoppers” completed a rating sheet for each encounter based on customer service values established by the Libraries. Data was analyzed and presented to staff. &#x0D; &#x0D; Results - Initial findings were generally quite positive but indicated that we could improve “going the extra mile” and “confirming satisfaction.” As a result, we developed training sessions for public services staff which were delivered during summer 2011. A LibGuide that included training videos was created for public services student employees who were required to view the videos and provide comments. In addition, we developed more specific public service standards for procedures such as answering the telephone, confirming satisfaction, and referring patrons to other offices. The Secret Shopper assessment was administered again in spring 2012 to see if scores improved. The results in the second study indicated improvement.&#x0D; &#x0D; Conclusions - The mystery shopper exercises provided the UNCG University Libraries with the opportunity to examine our services and customer service goals more closely. Conducting the mystery shopper study identified several areas to address. We realized we needed more clearly defined standards for staff to follow. We saw that we needed to discuss what “going the extra mile” means to us as an organization. We also needed to develop a scalable training method for student employees.

Evaluation of Pharmacists' Services for Dispensing Emergency Contraceptive Pills in Delhi, India: A Mystery Shopper Study.

Background:Although emergency contraceptive pills are available over the counter, the quality of consultation, including key areas of contraceptive counseling and prevention of sexually transmitted infections (STI), has not been well documented.Objective:To evaluate actual pharmacist services while dispensing emergency contraception through a mystery shopper technique.Material and Methods:This cross-sectional study was conducted in 81 pharmacies situated in Delhi by 4 trained mystery shoppers posed as customers over a period of 6 months.Results:None of the pharmacists asked about the time lapsed since last unprotected sexual intercourse or last menstrual period before deciding the eligibility of the customer. The majority were unclear about side effects associated with emergency contraception (78.57%) or with anticipated changes in menstrual flow (78.57%); 85.71% did not know whether subsequent unprotected intercourse would be protected. Only 15.71% counseled shoppers regarding risk of STI on asking leading questions and 88.5% did not provide any contraceptive advice.Conclusion:There is a huge gap in the technical knowledge and mindset of the pharmacists when it comes to checking for the eligibility of the client and providing advice regarding use of regular contraception and barrier for protection from STI, which needs to be addressed in order to realize the full benefit of making emergency contraceptive pills available over the counter.

How well are national guidelines relating to the general sales of aspirin and paracetamol, adhered to by retail stores: a mystery shopper study

ObjectiveTo determine whether non-pharmaceutical retail outlets are aboding to the current Medicines and Healthcare products Regulatory Agency (MHRA) national guidelines for over-the-counter (OTC) sales of aspirin and paracetamol.MethodsStages 1 and...

Advice on Weight Management: Are Pharmacy Staff Getting It Right? Results from a Mystery Shopper Study

The ability of patients to understand pharmacotherapy information is critical to the successful use of medications. One of the risk factors that may predispose the patient to non-adherence is the low retention of verbal information. Thereby, one way to facilitate the understanding of patients regarding prescribed pharmacotherapy is to incorporate pictograms to transmit information in a clear, expeditious, and simple manner.To evaluate literature on the use of pictograms for health professionals and assess their impact on helping patients increase the understanding of and compliance with medical instructions.Searches were conducted from February to March 2012. We searched articles in databases, using the keywords: “pictograms,” “health,” “health care professionals,” “medication” and “pictorial representation.” After this step, we performed a manual sorting, evaluating titles and abstracts. The articles were carefully examined according to the following variables: (1) geographic location and setting of the studies; (2) study design; (3) number of pictograms used; (4) education; (5) sample size; (6) age of participants; (7) function of pictograms; (8) limitations described in the literature evaluated.The research identified 136 published studies. After the exclusion process, 24 studies met inclusion criteria and from those, 50% were conducted in Africa, and 51.4% were considered effective. In the evaluation of the function of the pictograms, to verify their utility, 23 studies used to educate patients on the use of medications. The translation and cultural adaptation of pictograms was performed in five studies, and one study considered this process as validation.In this review, the literature contained only a few studies employing pictograms by health professionals, and most of these were meant for the use of medications. Moreover, the specific results reinforce the need for more studies in this area to provide a more complete approach about pictograms in the heath care.

Breastfeeding guidance in community pharmacies: The results of a mystery shopper study

AbstractAim: To assess the nature and quality of breastfeeding‐related guidance provided by community‐based pharmacy staff.Methods: A covert observational ‘mystery shopper’ study of 66 randomly selected community pharmacies was employed to assess actual breastfeeding guidance practices among pharmacy staff. A female mystery shopper used a scripted scenario designed to explore guidance practices relevant to breastfeeding promotion. Pharmacy staff: mystery shopper interactions were documented immediately following the exchange by the mystery shopper and a second shadow observer. These records were qualitatively analysed against a predetermined good practice framework of guidance expected for this scenario.Results: Of 66 pharmacies visited, the mystery shopper consulted with 18 pharmacists and 48 pharmacy assistants. Pharmacies visited included an equal mix of chain and independent pharmacies. The mean length of each mystery shopper to pharmacy staff interaction was 2.3 minutes (range of 0.5–10 minutes). In only 9 of 66 interactions was printed educational or product information provided to complement verbal advice. Most of this material (6/9) related to infant formula product information. Analysis of the content of guidance provided indicates limited advice being given regarding breastfeeding perseverance when confronted with breastfeeding difficulties (4/66), with most interactions involving direct advice regarding brands of infant formula to use.Conclusions: The quality of guidance provided by pharmacy staff in the context of breastfeeding promotion suggests a need for multistrategy intervention in the pharmacy setting and identifies a potential opportunity for collaborative interventions between nutrition, nursing and pharmacy practitioners to enhance infant‐feeding guidance.

Simulated Patient Studies: An Ethical Analysis

In connection with health care reform, the U.S. Department of Health and Human Services commissioned a "mystery shopper," or simulated patient study, to measure access to primary care. But the study was shelved because of public controversy over "government spying" on doctors. Opponents of the study also raised ethical concerns about the use of deception with human subjects without soliciting their informed consent. We undertook an ethical analysis of the use of simulated patient techniques in health services research, with a particular focus on research measuring access to care. Using a case study, we explored relevant methodological considerations and ethical principles relating to deceptive research without informed consent, as well as U.S. federal regulations permitting exceptions to consent. Several relevant considerations both favor and oppose soliciting consent for simulated patient studies. Making research participation conditional on informed consent protects the autonomy of research subjects and shields them from unreasonable exposure to research risks. However, scientific validity is also an important ethical principle of human subjects research, as the net risks to subjects must be justified by the value to society of the knowledge to be gained. The use of simulated patients to monitor access is a naturalistic and scientifically sound experimental design that can answer important policy-relevant questions, with minimal risks to human subjects. As interaction between researchers and subjects increases, however, so does the need for consent. As long as adequate protections of confidentiality of research data are in place, minimally intrusive simulated patient research that gathers policy-relevant data on the health system without the consent of individuals working in that system can be ethically justified when the risks and burdens to research subjects are minimal and the research has the potential to generate socially valuable knowledge.

Community pharmacists providing emergency contraception give little advice about future contraceptive use: a mystery shopper study

Background UK women increasingly prefer to attend a pharmacy for emergency contraception (EC) rather than a doctor. Most women who use EC do not conceive and remain at risk of pregnancy unless they start regular contraception. We undertook a study to evaluate the quality of service provision in community pharmacies in Lothian, Scotland, and to determine what advice is given about contraception after EC use. Study Design Mystery shopper study. Results EC was unobtainable from 5/40 pharmacies (12.5%), refused because of “contraindications” in 7 (17.5%) and offered in 28 (70%). Most pharmacists appeared nonjudgemental, over 75% asked appropriate questions about eligibility, and over 90% gave appropriate advice about use. EC was universally refused beyond 72 h after sex but universally provided when the date of the last menstrual period was uncertain. Ongoing contraception after EC use was discussed in only 32.5% of all pharmacies and only 43% of those issuing EC. Conclusions The quality of consultations for EC in pharmacies is generally good but only a minority discuss ongoing contraception after EC use. The implications for contraceptive use and unintended pregnancy rates are worrying.

STDs and HIV, chemists and the community in Nepal

Chemists play an important role in the health sector nationally in Nepal. They often serve as the first point of contact for and maybe the only source ofmodern health care in a rural village, including for STD treatment. A 1996 Mystery Shopper study found that less than one per cent of chemists suggested the right medication and the right dosage for a man who complained of symptoms of urethritis, only 14 per cent advised the use of condoms and only five per cent suggested partner referral for treatment. The Nepal Chemists and Druggists Association therefore set up a pilot training programme for 550 chemists in the Central Region to teach them about case management for STDs, interaction between STDs and HIV and how to do effective health education and prevention work including condom promotion, with clients at risk which will be completed and evaluated at the end of 1996.