Do north-eastern German pharmacies recommend a necessary medical consultation for acute diarrhoea? Magnitude and determinants using a simulated patient approach

Abstract

Background: To determine if pharmacy staff in Germany referred patients to a medical consultation for a scenario in which consulting a doctor was mandatory (‘appropriate outcome’) and what the quality of questioning and - if a medication was dispensed - the quality of information provided were in this context. Moreover, to determine which factors predicted a necessary referral to a doctor. Methods: A cross-sectional covert simulated patient study was conducted in a random sample of community pharmacies stratified by location in the German state of Mecklenburg-Vorpommern. Each pharmacy was visited once by one of four trained investigators. They simulated a symptom-based request involving a grandmother with acute diarrhoea. A multivariate binary logistic regression analysis using potential variables from bivariate analysis was carried out to determine the predictors for a referral to a doctor. Results: All 199 planned visits were conducted. A necessary referral to a doctor was recommended in 59.8% (n=119) of all test purchases. Multivariate analysis revealed that a non-pharmacist as opposed to a pharmacist and two or more questions as opposed to no questions were significantly associated with a referral to a doctor. Conclusions: Regarding the necessary referral to a doctor, an enormous potential for improvement was revealed for community pharmacies in the German state of Mecklenburg-Vorpommern. The results should make both the Mecklenburg-Vorpommern pharmacy association and legislators aware of the need to significantly escalate their quality management efforts.