Mystery Shopper Research Articles

Disposal of Unused Antibiotics in Community Pharmacies in Saudi Arabia: A Mixed-Methods Study.

Improper disposal of unused antibiotics poses a significant global challenge, drawing attention from various stakeholders. This discharge of antibiotics into the environment can occur through various means such as industrial production, consumption, and excretion by humans and animals, as well as improper disposal of unused or expired antibiotics. The aim of our study is to investigate the availability of proper disposal of antibiotics in community pharmacies and to explore obstacles and opportunities from pharmacist's point of view. This study used a mixed-methods approach that consisted of two study arms: quantitative and qualitative. The quantitative arm used a mystery-shopper method for assessing the disposal of antibiotics in community pharmacies. The qualitative study arm consisted of several in-depth semi-structured focus groups with a sample of pharmacists working in community pharmacies in Riyadh. The mystery shopper arm showed that 85% (n=88) refused to take the return of antibiotics. Interviews with pharmacists have indicated a lack of knowledge on safe disposal methods for antibiotics and medications. Additionally, pharmacists have cited several factors contributed to accumulation of the antibiotics such as nonadherence or policies mandating the sale of whole medication packs instead of the required amounts as a contributing factor to this issue. Furthermore, there is a lack of dedicated facilities for the population to safely dispose of their medications and/antibiotics. By acknowledging the factors contributing to improper disposal practices, recognizing the importance of proper antibiotic disposal, and advocating for multi-faceted initiatives, we can work towards mitigating this critical issue. Through collaborative efforts involving education, policy interventions, and community engagement, we can foster a culture of responsible medication disposal, ultimately safeguarding public health and environmental well-being.

OSAIRIS: Lessons Learned From the Hospital-Based Implementation and Evaluation of an Open-Source Deep-Learning Model for Radiotherapy Image Segmentation

Several studies report the benefits and accuracy of using autosegmentation for organ at risk (OAR) outlining in radiotherapy treatment planning. Typically, evaluations focus on accuracy metrics, and other parameters such as perceived utility and safety are routinely ignored. Here, we report our finding from the implementation and clinical evaluation of OSAIRIS, an open-source AI model for radiotherapy image segmentation that was carried out as part of its development into a medical device. The device contours OARs in the head and neck and male pelvis (referred to as the prostate model), and is designed to be used as a time-saving workflow device, alongside a clinician. Unlike standard evaluation processes, which heavily rely on accuracy metrics alone, our evaluation sought to demonstrate the tangible benefits, quantify utility and assess risk within a specific clinical workflow. We evaluated the time-saving benefit this device affords to clinicians, and how this time-saving might be linked to accuracy metrics, as well as the clinicians' assessment of the usability of the OSAIRIS contours in comparison to their colleagues' contours and those from other commercial AI contouring devices. Our safety evaluation focused on whether clinicians can notice and correct any errors should they be included in the output of the device.We found that OSAIRIS affords a significant time-saving of 36% (5.4 ± 2.1 minutes) when used for prostate contouring and 67% (30.3 ± 8.7 minutes) for head and neck contouring. Combining editing time data with accuracy metrics, we found the Hausdorff distance best correlated with editing-time, outperforming dice, the industry-standard, with a Spearman correlation coefficient of 0.70, and a Kendall coefficient of 0.52. Our safety and risk-mitigation exercise showed that anchoring bias is present when clinicians edit AI-generated contours, with the effect seemingly more pronounced for some structures over others. Most errors, however, were corrected by clinicians, with 72% of the head and neck errors 81% of the prostate errors removed in the editing step. Notably, our blinded clinician contour rating exercise showed that gold standard clinician contours are not rated more highly than the AI-generated contours.We conclude that evaluations of AI in a clinical setting must consider the clinical workflow in which the device will be used, and not rely on accuracy metrics alone, in order to reliably assess the benefits, utility and safety of the device. The effects of human-AI inter-operation must be evaluated to accurately assess the practical usability and potential uptake of the technology, as demonstrated in our blinded clinical utility review. The clinical risks posed by the use of the device must be studied and mitigated as far as possible, and our ‘Mystery Shopping’ experiment provides a template for future such assessments.

Pharmacists’ mental health support behaviours with simulated patients: a mixed-methods pilot study

BackgroundSimulated mental health role-plays provide a safe and relevant learning experience for pharmacy students, improving confidence in and attitudes toward providing mental health support. Little research explores the use of mental health role-plays, enacted by trained actors, with pharmacists. ObjectivesThis study aimed to pilot the adaptation of simulated patient (SP) role-plays, from the university classroom with students, to a workshop with pharmacists, and explore pharmacists’ experiences. MethodsPharmacists attended a two-hour workshop. Trained actors enacted simulated scenarios (previously developed for pharmacy education) with pharmacist volunteers while being observed by peers, a workshop facilitator, and mental health consumer educator (MHCE). Pharmacists engaged in self-assessment immediately post-roleplay, followed by performance feedback and debrief discussions with MHCEs, workshop facilitators, and peers. Pharmacists completed pre- and post-workshop surveys exploring intended mental health support behaviours, then invited to participate in an interview exploring their workshop experiences and opinions about using mental health role-plays in clinical practice (via mystery shopping). Non-parametric tests were conducted to analyse role-play and survey scores, and thematic analyses were undertaken on interview transcripts. ResultsThirty-five pharmacists attended the workshop. Fourteen role-plays were analysed. Pharmacist self-assessment scores were significantly lower than MHCE scores (P = 0.028). Overall, the role-plays significantly increased pharmacists’ intentions in supporting a person experiencing mental health crises such as suicide and psychosis, as well as encouraging other supports (P < 0.05). Four themes emerged from interviews (n = 4): realistic context for skills application and practice, benefits of observing, self-assessment and feedback, and integrating into clinical practice (via mystery shopping). ConclusionSP role-plays of mental health symptoms and crises, enacted by trained actors, may effectively assess and enhance pharmacists’ intended mental health support behaviours. It is recommended that the SP method is adapted into clinical practice, via repeated mystery shopping visits with immediate performance feedback, to shape pharmacists’ mental health support behaviours.

"I was given PrEP, but had no privacy": Mystery shopper perspectives of PrEP counseling for adolescent girls and young women in Kisumu County, Kenya.

Pre-exposure prophylaxis (PrEP) is being scaled up to prevent HIV acquisition among adolescent girls and young women (AGYW) in Eastern and Southern Africa. In a prior study more than one-third of AGYW 'mystery shoppers' stated they would not return to care based on interactions with health providers. We examined the experiences of AGYW in this study to identify main barriers to effective PrEP services. Unannounced patient actors (USP/'mystery shoppers') posed as AGYWs seeking PrEP using standardized scenarios 8 months after providers had received training to improve PrEP services. We conducted targeted debriefings using open-ended questions to assess PrEP service provision and counseling quality with USPs immediately following their visit. Debriefings were audio-recorded and transcribed. Transcripts were analyzed using thematic analysis to explore why USPs reported either positive or negative encounters. We conducted 91 USP debriefings at 24 facilities and identified three primary influences on PrEP service experiences: 1) Privacy improved likelihood of continuing care, 2) respectful attitudes created a safe environment for USPs, and 3) patient-centered communication improved the experience and increased confidence for PrEP initiation among USPs. Privacy and provider attitudes were primary drivers that influenced decision-making around PrEP in USP debriefs. Access to privacy and improving provider attitudes is important for scale-up of PrEP to AGYW.

Cigarette Sales to Underage Youth in Seoul, South Korea: Findings From a Mystery Shopping Study.

This study aimed to identify the rates of cigarette sales to underage youth and the factors associated with these sales using a mystery shopping technique. Of the convenience stores selling cigarettes in Seoul, South Korea, 2600 were sampled in 2019 and 2020. Personal and environmental factors were independent variables. Cigarette sales to underage youth were the outcome variable, defined as cases where a seller sold cigarettes to a youth shopper. A multiple logistic regression analysis was performed. Rates of cigarette sales to underage youth were 17.9% in 2019 and 16.3% in 2020, significantly higher when the seller was younger and the store was located in a central area. Administrative actions are needed to enforce strong warnings and training guidelines for convenience store sellers. Differentiation in surveillance intensity based on the location of convenience stores in Seoul is also recommended.

Patient actor training improves preexposure prophylaxis delivery for adolescent girls and young women in Kenya: a cluster randomized trial.

To evaluate effectiveness of a standardized patient actor (SP) training intervention to improve quality of preexposure prophylaxis (PrEP) services for adolescent girls and young women (AGYW) in Kenya. Cluster randomized trial and mystery shopper evaluation. Twelve of 24 maternal child health and family planning facilities were randomized to SP training. Providers at intervention facilities participated in 2-day training in adolescent health, PrEP guidelines, values clarification, and communication skills, followed by role-playing and de-briefing with trained actors. Control facilities received standard national training. The primary outcome was quality of care, assessed by unannounced SPs (USPs) or "mystery shoppers" blinded to intervention arm. Quality was measured in two domains: guideline adherence and communication skills. Intent to treat analysis compared postintervention quality scores by randomization arm, clustering on facility, and adjusting for baseline scores and USP. Overall, 232 providers consented to USP visits, and 94 providers completed the training. Following training, USPs posed as AGYW seeking PrEP in 142 encounters (5-6 encounters per site). The mean quality score was 73.6% at intervention sites and 58.4% at control sites [adjusted mean difference = 15.3, 95% confidence interval (CI): 9.4-21.1, P < 0.001]. Mean guideline adherence scores were 57.2% at intervention sites and 36.2% at control sites (adjusted mean difference = 21.0, 95% CI: 12.5-29.4, P < 0.001). Mean communication scores were 90.0% at intervention sites and 80.5% at control sites (adjusted mean difference = 9.5, 95% CI: 5.5-13.6, P < 0.001). SP training significantly improved quality of PrEP care for AGYW in Kenya. Incorporating SP training and unannounced SP evaluation could improve PrEP uptake among AGYW.

Specialist vape store audit reveals poor compliance with new e-cigarette regulations

aim: Regulations announced in mid-2023 aimed to reduce youth vaping by curtailing the availability of cheap high-nicotine e-cigarettes (vapes). This study tested compliance with the new regulations for single-use vapes, which came into force on 21 December 2023. methods: A 20-year-old “mystery shopper” visited 96% of specialist vape retailers (SVRs) in Wellington, Porirua, Lower Hutt and Upper Hutt (N=74) in January 2024, and observed i) R18 signage, ii) age verification practices, and ii) prices and brands of the cheapest available vaping products. Low-price vapes were purchased and inspected for compliance with new nicotine limits and safety regulations. results: All but three stores (96%) displayed an R18 sign; however, signage in 29 stores (39%) was suboptimal. Only one store (1.4%) requested age identification (ID) on entry to the R18 premises. In 50% of stores, ID was requested when a purchase was made; however, a third of those retailers proceeded with the sale despite the buyer not providing ID. Single-use vapes remained available for NZ$10 or less in most stores, and reusable starter kits were also widely available for NZ$10–20. Discounted high-nicotine products were sold for as little as NZ$2.50 each. Most low-price products did not comply with the updated regulations. conclusion: Cheap, high-nicotine vaping products remained widely available following the introduction of stricter regulations in December 2023; products for sale included discounted and non-compliant vapes. The majority of SVRs had poor age verification practices. There is an urgent need to clarify rules, increase enforcement efforts and disallow discounting and giveaways of vapes.

Test purchasing of same day and rapid online alcohol home delivery in two Australian jurisdictions.

With same day online alcohol sales increasing, there is a need to study their regulation. Test purchasing of alcohol home delivery was conducted to measure compliance with regulations for identification checks and unattended deliveries in two Australian jurisdictions (Perth, Western Australia and Geelong, Victoria), which have differing regulations. Alcohol orders for same day or rapid (<2 hours) delivery on Friday and Saturday nights were made by research assistants aged 18-24 years in Perth (n=34) and Geelong (n=29). An observation checklist was used to record the delivery interaction, with a specific focus on checking of photo identification at time of delivery and whether deliveries were left unattended. Average time from order to delivery for rapid deliveries was less than one hour in both sites (Perth = 50 minutes; Geelong = 36 minutes). More than 20% of deliveries were made without an identification check in both sites (Perth = 24%; Geelong = 21%). This pilot study showed alcohol can be delivered to the home within one hour, and not all deliveries include an identification check at point of delivery. These findings indicate a need for policies that empower regulators and police to undertake 'mystery shopper' monitoring to reduce potential harms and improve compliance with alcohol delivery policy.

Non-prescription sale and dispensing of antibiotics for prophylaxis in broiler chickens in Lusaka District, Zambia: findings and implications on one health.

The irrational use of antibiotics in humans and livestock has contributed to the emergence of antimicrobial resistance (AMR). This study investigated the commonly sold and dispensed antibiotics for prophylaxis in broiler chickens in pharmacy and agro-veterinary shop personnel in the Lusaka District of Zambia. This cross-sectional study was conducted from August 2023 to October 2023 among 200 veterinary medicine dispensers in the Lusaka District of Zambia using a simulated farmer or mystery shopper approach. Data analysis was performed using IBM Statistical Package for Social Sciences version 23.0. Out of the 200 medicine outlets investigated, 23 (11.5%) were agro-veterinary shops, while 177 (88.5%) were community pharmacies. A total of 165 community pharmacies and agro-veterinary shops provided veterinary services in the Lusaka District and sold medicines without prescription giving a 100% non-prescription sale. Of the 178 medicines dispensed for prophylaxis, 88.5% were antibiotics, while 13.5% were vitamins. The most dispensed antibiotic drug for prophylaxis in broiler chickens was oxytetracycline (30.34%), amoxicillin (17.98%) and gentamicin/doxycycline (10.67%). This study revealed a high sale and dispensing of antibiotics for prophylaxis in broiler chickens of which oxytetracycline, amoxicillin and gentamicin/doxycycline were commonly dispensed. There is a need for increased regulatory enforcement of selling antibiotics without a prescription as this may predispose poultry to the development of AMR and possible transmission of superbugs to humans and the environment. Educational interventions should be provided to community pharmacy and agro-veterinary personnel on adhering to antimicrobial stewardship practices when dispensing poultry antibiotics.

Recognizing the opportunity to directly de-label no-risk penicillin allergies in community pharmacy: a mystery shopper experience.

Incorrect labelling of a penicillin allergy can lead to unnecessary use of broad-spectrum, less effective, more harmful, or more costly antibiotics. Community pharmacists are well positioned to educate the public on penicillin allergies, prevent incorrect labelling persisting, and optimize prescribing of antibiotics. This study investigated community pharmacists' capacity to recognize an opportunity to directly de-label a no-risk penicillin allergy. A sequential explanatory mixed methods design using mystery shopping (quantitative) and postvisit reflections (qualitative). Mystery shoppers simulated a case of a previously dispensed prescription (involving nonimmune mediated intolerance 'thrush' as the reported allergy) that provided the opportunity for pharmacists to educate on incorrect penicillin allergy. The main outcomes were proportion of community pharmacists who ascertained the nature of the penicillin reaction, provided education on incorrect penicillin allergy labels and its consequences. Knowledge and practices regarding penicillin allergy were collected. Across two major states in Australia, 265 community pharmacists participated. Only 44.5% (118/265) of pharmacists asked about the nature of the reaction; of those, 91.52% (108/118) indicated that 'thrush' is not an allergic reaction. No pharmacists took the opportunity to educate on how an incorrect allergy label can impact antibiotic prescribing. Postvisit reflection data revealed five probable explanations for the observations viz. outdated knowledge, lack of knowledge, prioritizing management of adverse drug reaction (thrush), variations in duty of care and assumption of true allergy without an assessment. Our findings underscore a concerning knowledge and practice gap among community pharmacists regarding penicillin allergy assessment which warrants more support and education in the community pharmacy sector.

Medication use review as a service for pharmaceutical care: Conditions for implementation in pharmacy practice

&#x0D; &#x0D; &#x0D; Pharmaceutical care is an aggregated pharmaceutical service based on an innovative approach towards the patient’s pharmacotherapy process. It was introduced into the Polish pharmaceutical law system in 2008, but it was not until the end of 2020 that the list of activities included in this innovative health service was clarified. The delayed initiation of pharmaceutical care means that implementation procedures are lacking, making it difficult to fully implement it into pharmacy practice. The initiating service for pharmaceutical care in pharmacy practice is the medication use review (MUR), which, combined with the pharmacotherapy assessment, has the task of detecting and solving patients’ drug-related problems and thus ensuring safety in the pharmacotherapy process. Such important objectives for medication use review face organisational barriers that make its effective implementation difficult and practically impossible, limiting the scope of pharmaceutical care to the consultative aspect in practice. The aim of the article is to present the implementation conditions of medication use reviews in Polish pharmacy practice, which helped to identify the conditions for effective implementation of pharmaceutical care. Achieving the research objectives requires the use of a variety of research methods. To identify the conditions for effective implementation of medication use reviews, the method of analysis of legal acts was used. Apart from that, the analysis of literature and the method of examination of documents were also implemented, which made it possible to determine whether the Polish pharmaceutical law system creates conditions for effective provision of this service in pharmacy practice. The method of observation (the mystery shopper) was also used to indicate the territorial (subjective scope) scope of the provision of medication use review and to identify barriers to their implementation in Polish organisational and legal realities. All the methods applied made it possible to determine to what extent pharmacist shortages in the pharmacy limit the implementation process. The results of the study were subjected to statistical analysis.&#x0D; &#x0D; &#x0D;

GP access for inclusion health groups: perspectives and recommendations.

General practice has seen the widespread adoption of remote consulting and triage systems. There is a lack of evidence exploring how inclusion health populations have been impacted by this transformation. This study aimed to explore the post-pandemic GP access for inclusion health populations, through the lens of those with lived experience, and identify practical recommendations for improving access for this population. A mixed-methods study exploring the direct experience of people from inclusion health groups trying to access GP care in 13 practices in east London. A mystery shopper exercise involving 39 in-person practice visits and 13 phone calls were undertaken. The findings were reflected on by a multidisciplinary stakeholder group, which identified recommendations for improvements. Only 31% of the mystery shopper visits (n = 8) resulted in registration and the offer of an appointment to see a GP for an urgent problem. None of the mystery shoppers was able to book an appointment over the phone but n = 10/13 felt that they would be able to register and make an appointment if they followed the receptionist's instructions. Most mystery shoppers felt respected, listened to, and understood the information provided to them. Just under half of the practices (46%, n = 6) received positive comments on how accessible and supportive their spaces felt. Practice- and system-level recommendations were identified by the stakeholder group. Ongoing GP access issues persist for inclusion health populations. We identified practice- and system-level recommendations for improving access for this vulnerable population.

Determination of the Prevalence of Different Brands of Fixed Dose Artemether/Lumefantrine Tablets Sold in Pharmacies in Uganda

Substandard, counterfeit and falsified antimalarial agents are a big challenge to effective malaria elimination interventions mainly in developing countries. In low-and middle-income countries (LMICs), the quality of antimalarial agents inclusive of AL is affected by several factors including insufficient regulation porous borders and limited funds. This study therefore focused evaluation of quality of different brands of fixed dose artemether/ lumefantrine tablets sold in Ugandan Pharmacies. This was an experimental study conducted using AL tablets obtained from different pharmacies in the different cities of Uganda purchased using mystery shopper method. The samples were screened for quality using visual inspection, assessed different physical quality parameters like weight variation, friability, disintegration and dissolution and content assay tests were also done both for the brands from the pharmacies and their correspondent LTR. The assay test was done using HPLC technique USP method. The samples were considered substandard if the API content was outside 90-110% range of the label claim. Data was analysed using descriptive statistics and presented as means with standard deviations and frequencies. 400 AL samples were collected from the different Pharmacies in the different cities and the corresponding LTRs in the strengths of 20/120, 60/360 and 80/480 with commonest brands Lumartem, Lumaren and Artefan. The presence of A/L brands that are unregistered and the total assay failure of the brands of 18% for the AL tablets purchased causes alarm. Keywords: Artemether lumefantrine, quality, tablets, prevalence

БІЗНЕС-МОДЕЛІ ОСНОВНИХ ГРАВЦІВ НА ПОЛІ ЦИФРОВОЇ ДИСТРИБУЦІЇ ЕЛЕКТРОННИХ КНИЖОК В УКРАЇНІ. 2011–2023

&lt;p&gt;&lt;em&gt;A new field of e-book distribution has emerged and developed in Ukraine due to the impact of digital technology on the publishing industry.&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;This research aims to&lt;/em&gt;&lt;/strong&gt;&lt;em&gt;: Identify the key players in the field of digital distribution of e-books by Ukrainian publishers from 2011 to 2023. Analyse and describe the value propositions and business models of digital book distribution start-ups in Ukraine.&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Research methodology. &lt;/em&gt;&lt;/strong&gt;&lt;em&gt;The study analyses the value propositions and business models of various companies operating in e-book distribution in Ukraine, using the case study method and mystery shopping. The generalisation of the data obtained as a result of the case study was achieved by using historical, analytical, synthetic and comparative methods, classification methods and a systematic approach.&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Results. &lt;/em&gt;&lt;/strong&gt;&lt;em&gt;Thirteen players were found to be active in e-book distribution between 2011 and 2023 (seven entered the market in 2011&lt;/em&gt;&lt;em&gt;–&lt;/em&gt;&lt;em&gt;2018 and another six in 2019&lt;/em&gt;&lt;em&gt;–&lt;/em&gt;&lt;em&gt;2023), with three platforms closing in the last five years. Of the ten active players, six specialise in e-book sales with a «digital only» business model (Booxters, Booknet, Chytanka, Librarius, Pocketbook) and four are online bookstores with an omnichannel business model, selling both print books and e-books (Yakaboo, KnigoLand, Knygarnya «E», Nash format). The main business model for all players in e-book distribution is direct sales, although distributors are increasingly adopting combined business models (direct sales plus subscription). A positive trend is the implementation in the field of digital distribution of e-books in Ukraine of business models that are popular in foreign digital publishing, in particular, self-publishing (Booknet) and e-book lending (Librarius). Important for the development of Ukrainian digital book production and sales is the focus of distributors on ensuring closed access and strict protection of book content against piracy sharing.&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;The novelty &lt;/em&gt;&lt;/strong&gt;&lt;em&gt;lies in the development of a chronological list of the main players who have worked (or are working) in the field of digital distribution of Ukrainian e-books; identifying their business models and analysing their value propositions: e-book formats, types of access to content and ways of protecting content.&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Practical significant&lt;/em&gt;&lt;/strong&gt;&lt;em&gt;. The results of this research will be used in lectures for students of the educational program «Publishing and editing» in Ukrainian universities, and will also draw the attention of the publishing community to the problems of the development of digital book publishing.&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Key words&lt;/em&gt;&lt;/strong&gt;&lt;em&gt;: bookselling, business models, digital distribution, digital book publishing, e-book, field of digital distribution, omnichannel.&lt;/em&gt;&lt;/p&gt;

Determination of Concentration of Active Pharmaceutical Ingredients in Different Brands of Artemether/Lumefantrine Tablets Sold in the Pharmacies in Uganda

Substandard, counterfeit and falsified antimalarial agents are a big challenge to effective malaria elimination interventions mainly in developing countries. In low-and middle-income countries (LMICs), the quality of antimalarial agents inclusive of AL is affected by several factors including insufficient regulation porous borders and limited funds. This study therefore focused evaluation of quality of different brands of fixed dose artemether/ lumefantrine tablets sold in Ugandan Pharmacies. This was an experimental study conducted using AL tablets obtained from different pharmacies in the different cities of Uganda purchased using mystery shopper method. The samples were screened for quality using visual inspection, assessed different physical quality parameters like weight variation, friability, disintegration and dissolution and content assay tests were also done both for the brands from the pharmacies and their correspondent LTR. The assay test was done using HPLC technique USP method. The samples were considered substandard if the API content was outside 90-110% range of the label claim. Data was analysed using descriptive statistics and presented as means with standard deviations and frequencies. Out of the 16 brands in the study, 14 brands (88%) passed the artemether assay and two brands failed at 89.8% and 110.2% of declared artemether content. For Lumefantrine assay, out of the 16 brands in the study, 14 brands (88%) passed the Lumefantrine assay except two brands (12%). The presence of A/L brands that are unregistered and the total assay failure of the brands of 18% for the AL tablets purchased causes alarm and the total assay failure of the brands of 18% for the AL tablets purchased calls for NDA to intensify on its operations to find out the conformity of the pharmacies to selling only registered medicines. Keywords: Artemether Lumefantrine, Quality, Tablets

Exploring nonstandard service frontline situations

THE AIMS OF THE PAPER Jaycustomer behavior often increases the unpredictability of the service to an unmanageable extent. A co-creation based development can be presumed in the attitude of the consumer and of the frontline staff. The primary goal of this research was to investigate the dynamics of interactions between customers and frontline staff, particularly in nonstandard situations. This study aimed to understand how 'jaycustomer' behavior, which includes unpredictable and challenging customer actions, impacts these interactions and the overall service process. METHODOLOGY To explore the above, the study employed a quasi-secondary data collection method (narratives, netnography). Frontline conflicts were simulated based on a mystery shopping scenario. Mystery shoppers were instructed to combine two theoretical jaycustomer types – the Belligerent and the Egocentric Edgar (the selfish) – in their approach. These shoppers were tasked with observing various aspects of frontline staff behavior, including reactions, communication, gestures, and problem-solving intentions. MOST IMPORTANT RESULTS The simulations led to the identification of distinct behavioral patterns on both sides of the customer-staff interaction. The study highlighted specific jaycustomer oriented patterns and the frontline staff's response strategies. Furthermore, essential human resource management skills in dealing with such jaycustomer scenarios were identified, providing insights into both customer and employee behavior in challenging service situations. RECOMMENDATIONS The findings of this research offer significant implications for service management and marketing theory, particularly in developing a consensual model for managing frontline processes. Additionally, the study suggests that reviewing and aligning staff training content with these research findings could be a fruitful direction for enhancing human resource management practices in customer service environments. An expert interview conducted post-experiment further affirmed special tasks for frontline management to handle such jaycustomer situations effectively.

WAYS OF IMPROVING SERVICE QUALITY IN NETWORK RETAIL

The article examines the ways to increase the efficiency of the retail network by involving consumers in making purchases in retail stores and a high level of their loyalty as a determining factor in the growth of turnover in the conditions of martial law. Methods of assessing the quality of service in trade enterprises have been established depending on the specifics of their activity and the degree of adaptation to changes in the external environment for the purposes of attracting and maintaining consumer loyalty. General trends in the development of modern retail, features of the sales funnel are considered. The most influential factors on the organization of business entities in the field of trade are identified, in particular: digitization of trade and technological processes and customer retention thanks to artificial intelligence; expansion of the virtual trading space and automation of internal processes; personalization of customer service. The identification of modern trends in the development of trade determines the needs of consumers, their behavior, and the choice of a sales system at a particular enterprise. It has been established that the use of generally accepted approaches to the formation of the sales funnel in the practice of trade enterprises allows to increase the volume of sales of goods and the level of profitability of the activity. According to this approach, the tasks of the staff are determined in relation to interaction with customers, focusing on their motivation to make a purchase. A study of the degree of consumer satisfaction was carried out and the level of service was determined for the purposes of further choosing the model of motivation of sales staff in the chain of stores «Yves Rocher» using the Mystery Shopping method. To calculate the level of service, a questionnaire developed by Yves Rocher was used, consisting of the following blocks: general impressions; subjective impressions; evaluation of sales processes; working with objections; assessment of the work of cashiers and external factors. The point system and evaluation method were defined. Based on the Harrington scale, a modified mystery shopper evaluation matrix was developed. The characteristics of each evaluation are highlighted to clarify the degree of performance of functional duties by personnel and to identify key areas of improvement. The level of service was established for seventeen stores of the Yves Rocher chain, with information on the subjective impression of a mystery shopper from a visit to the stores, which was evaluated on a ten-point scale. Based on the results of the Mistery Shopping evaluation, it was found that 6 stores have an excellent level of service, 4 are good, 2 are satisfactory, and 5 are acceptable. The conducted studies are of a universal nature, and the involved approaches can be used by retail enterprises to identify reserves for improving the level of service quality.

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.

Physician beneficence and profit-taking among private for-profit clinics in China: A field study using a mystery shopper audit

This study employs a mystery shopper audit on a random sample of 96 for-profit private clinics in Jinan, China. We investigate two instruments which reflect beneficence among for-profit clinicians in private practice. The first is whether physicians returned a lost wallet “accidentally” left next to the physician’s table; and the second, whether physicians prescribed antibiotics to pseudo-patients who displayed no symptoms of any illness but had complained of fever the night before. These measures quantify beneficence under two different valence framing: returning a wallet represents clinicians who “do good” at personal cost to themselves, while not prescribing antibiotics represents a choice “not to do harm” to patients. We look at the correlation between these beneficence measures and the physicians’ prescription behaviors, and their revenues from the consultation. We find that whether doctors return a lost wallet or not, and prescribe antibiotics or not, such physicians are still as likely to prescribe medications which increase their incomes.