# Dispensing of Prescribed Medicines in Swiss Community Pharmacies-Observed Counselling Activities
## 1 Introduction  
The Pharmaceutical Care Network Europe defined \"Pharmaceutical Care\" as \"the pharmacist's contribution to the care of individuals in order to optimize medicines use and improve health outcomes provided\" [1]. As part of pharmaceutical care, patient counselling and addressing drug-related problems (DRPs) are the pharmacist's key activities to ensure the safe and effective use of medicines [2; 3]. Dispensing includes all activities between the reception of the patient with a prescription and the distribution of medicines to the patient with the provision of counselling [2]. During dispensing, community pharmacists help the patient to make the best use of prescribed medicines by providing written and oral information, responding to the patients' needs [4]. Patients have the opportunity to receive counselling and education about their health problems and medicinesin several care situations, especially in community pharmacies at the time of dispensing prescribed medicines [5]. Patient counselling about their medicines (e.g., administration, risks and benefits) has been shown to be effective in improving medicine adherence [6; 7], and in identifying DRPs [8]. In contrast, insufficient information about medicines can lead to patient non-adherence to drug therapy, and negative health outcomes [5]. The joint International Pharmaceutical Federation and World Health Organization (FIP/WHO) guidelines on Good Pharmacy Practice (GPP) describes the pharmacist's function of dispensing medicines concerning counselling as \"providing advice to ensure that the patient receives and understands sufficient written and oral information to derive maximum benefit for the treatment\" [3]. Prescription dispensing at the community pharmacy is an important contact point for patient counselling [8]. Patients regularly pick up their prescribed medicines in community pharmacies [9], hence pharmacy staff are usually one of the last healthcare providers who interact with patients prior to medication intake that has the possibility to counsel them [10; 11]. The joint FIP/WHO GPP also suggests minimum national standards that should be established for this function. In Switzerland, the Swiss Association of Pharmacists published standards for pharmaceutical counselling [12]. A service-based remuneration system for community pharmacies has been established since 2001 [13] and some cognitive pharmaceutical services are reimbursed by the health insurance [14; 15]. The counselling provided during dispensing of prescribed medicines is remunerated by the 'drug check' (fixed fee for checking each dispensed item for dosage, interactions, risk factors, contraindications, misuse and for patient counselling, choice of optimal package size, etc.) and 'delivery check' (fixed fee for managing a patient record and checking medication history) [14]. In Switzerland, prescribers can issue refill prescriptions for up to 12 months for patients with ongoing long-term therapies, leaving responsibility for counselling and follow-up of therapy to the pharmacist. The literature on counselling in community pharmacies described the communication between patient and provider about the medicines use [16; 17] and compared counselling practice to guidelines [9; 18]. A Swiss study described community staff-patient interactions with a focus on adherence [19]. This study showed that only 6.7% of all patient interactions comprised adherence counselling, and recommended an in-depth analysis of pharmacist-patient interaction. To the authors' knowledge, the full pattern of the daily community pharmacy practice, with all activities and interventions a prescription triggers at the time of dispensing in a setting with remuneration for prescription validation and counselling, have not been described yet.