Evaluation of the supply of antifungal medication for the treatment of vaginal thrush in the community pharmacy setting: a randomized controlled trial
Keywords:Patient Simulation, Candidiasis, Vulvovaginal, Community Pharmacy Services, Professional Practice, Pharmacies, Australia
Background: The Pharmaceutical Society of Australia have developed “guidance” for the supply of several medicines available without prescription to the general public. Limited research has been published assessing the effect of these guidelines on the provision of medication within the practice of pharmacy.
Objectives: To assess appropriate supply of non-prescription antifungal medications for the treatment of vaginal thrush in community pharmacies, with and without a guideline. A secondary aim was to describe the assessment and counseling provided to patients when requesting this medication.
Methods: A randomized controlled trial was undertaken whereby two simulated patients conducted visits to 100 randomly selected community pharmacies in a metropolitan region. A product-based request for fluconazole (an oral antifungal that has a guideline was compared to a product-based request for clotrimazole (a topical antifungal without a guideline). The same patient details were used for both requests. Outcome measures of the visits were the appropriateness of supply and referral to a medical practitioner.
Results: Overall 16% (n=16) of visits resulted in an appropriate outcome; 10% (n=5) of fluconozaole requests compared with 22% (n=11) of clotrimazole requests (chi-square=2.68, p=0.10). There was a difference in the type of assessment performed by pharmacy staff between visits for fluconazole and clotrimazole. A request for clotrimazole resulted in a significant increase in frequency in regards to assessment of the reason for the request (chi-square=8.57, p=0.003), symptom location (chi-square=8.27, p=0.004), and prior history (chi-square=5.09, p=0.02).
Conclusions: Overall practice was poor, with the majority of pharmacies inappropriately supplying antifungal medication. New strategies are required to improve current practice of community pharmacies for provision of non-prescription antifungals in the treatment of vaginal thrush.
2. Pharmaceutical Society of Australia. Supply of levonorgestrel as a Pharmacist Only Medicine for emergency contraception (EC). Canberra: PSA, 2011.
3. Pharmaceutical Society of Australia. Provision of orlistat as a Pharmacist Only Medicine. Canberra: PSA, 2005.
4. Pharmaceutical Society of Australia. Provision of oral fluconazole as a Pharmacist Only Medicine for the treatment of vaginal candidiasis. Canberra: PSA, 2005.
5. Pharmaceutical Society of Australia. Provision of pantoprazole as a Pharmacist only medicine. Canberra: PSA, 2008.
6. Pharmaceutical Society of Australia. Provision of chloramphenicol for ophthalmic use as a Pharmacist Only medicine. Canberra: PSA, 2010.
7. Watson MC, Bond CM, Grimshaw JM, Mollison J, Ludbrook A, Walker AE. Educational strategies to promote evidence-based community pharmacy practice: a cluster randomized controlled trial (RCT). Fam Pract. 2002;19(5):529-536.
8. Watson MC, Bond CM; Grampian Evidence Based Community Pharmacy Guidelines Group. Evidence-based guidelines for non-prescription treatment of vulvovaginal candidiasis (VVC). Pharm World Sci. 2003;25(4):129-134.
9. Watson MC, Bond CM, Walker A, Grimshaw J. Why educational interventions are not always effective: a theory-based process evaluation of a randomised controlled trial to improve non-prescription medicine supply from community pharmacies. Int J Pharm Pract. 2006;14(4):249-254. doi: 10.1211/ijpp.14.4.0004
10. Schneider CR, Everett AW, Geelhoed E, Kendall PA, Clifford RM. Measuring the assessment and counselling provided with the supply of non-prescription asthma reliever medication: a simulated patient study. Ann Pharmacother. 2009;43(9):1512-1518. doi: 10.1345/aph.1M086
11. Schneider CR, Everett AW, Geelhoed E, Kendall PA, Murray K, Garnett P, Salama M, Clifford RM. Provision of primary care to patients with cough in the community pharmacy setting. Ann Pharmacother. 2011;45(3):402-408. doi: 10.1345/aph.1P514
12. Norris P. Purchasing restricted medicines in New Zealand pharmacies: results from a "mystery shopper" study. Pharm World Sci. 2002;24(4):149-153.
13. Benrimoj SI, Werner JB, Raffaele C, Roberts AS. A system for monitoring quality standards in the provision of non-prescription medicines from Australian community pharmacies. Pharm World Sci. 2008;30(2):147-153.
14. Bissell P, Ward PR, Noyce PR. Variation within community pharmacy. Part 1. Responding to requests for over-the-counter medicines. J Soc Admin Pharm 1997;14(1):1-15.
15. Watson MC, Hart J, Johnston M, Bond CM. Exploring the supply of non-prescription medicines from community pharmacies in Scotland. Pharm World Sci. 2008;30(5):526-535. doi: 10.1007/s11096-008-9202-y
16. John DN, Krska J, Hansford D. Are customers requesting medicines by name less likely to be advised or referred? Provision of over-the-counter H2-receptor antagonists and alginate products from pharmacies. Int J Pharm Pract 2003;11(1):33-39.
17. Kelly FS, Williams KA, Benrimoj SI. Does Advice from Pharmacy Staff Vary According to the Nonprescription Medicine Requested? Ann Pharmacother. 2009;43(11):1877-1886. doi: 10.1345/aph.1L121
18. Emmerton L, Shaw J. The influence of pharmacy staff on non-prescription medicine sales. Int J Pharm Pract. 2002;10(2):101-106.
19. Bissell P, Ward PR, Noyce PR. Variation within community pharmacy. Part 2. Responding to the presentation of symptoms. J Soc Admin Pharm. 1997;14(2):105-15.