# Dispensing of Prescribed Medicines in Swiss Community Pharmacies-Observed Counselling Activities
## 4 Discussion
### Counselling
#### 4.1.2 Factors Influencing Counselling Provision  
Counselling was not equally provided, suggesting that pharmacy staff use different levels of counselling at PEs. If extended counselling at each first and refill PE is not possible in daily practice, pharmacy staff should target counselling for specific situations. However, it is important to notice that each PE offers to the pharmacist an opportunity to interact with the patient and hence to detect DRPs and patients' concerns. The study findings highlight some factors influencing counselling provision at the patient, prescription and provider level. These indicators could help in prioritizing prescriptions needing in-depth counselling. Patient level
* New customers were more likely to receive counselling from the pharmacy staff than regular customers. The counselling patterns revealed that the pharmacy staff performed more likely an anamnesis (medicine, diseases, and allergy) with the new customers, while the counselling patterns of the other factors influencing counselling provision were comparable (Figure 2). Similarly, to a review [17], the pharmacy staff mainly counselled on administration, dose and use. * Customers who did not refuse counselling received more counselling. Refusing counselling did not mean that the patient did not receive any counselling, but such refusal is known to be an important barrier for the provision of counselling [19]. Lack of patient interest is a common phenomenon during counselling in community pharmacy [38; 39], up to 41-63% patients decline a counselling offer [33; 40], leading to low counselling ratios [40]. * Caers who filled a prescription for a patient received more information on the prescribed medicines than the patients themselves. Possibly, the carer was not present at the consultation with the prescriber and did not receive information on the patient's drug therapy. Prescription level
* Customers with a first prescription received more counselling than customers with a refill prescription. In a first PE, it is important to ensure that the patient receives the knowledge for using their medicines correctly [19]. Appropriate drug use is ensured by counselling on therapy duration, dosage, and optimal timing of drug intake [46]. At refill PE, pharmacists could suppose that patients with chronic medication were already informed about their use [47]. They could also be regular customers needing less clarification. Previous studies showed that pharmacy staff classified the communication with patients to be more difficult during refill PE than during the first PE [48; 49]. It has been shown that patients' expectations towards counselling are different in first and refill PEs. More interest by patients during a first PE may facilitate more extensive counselling [40]. This is in line with the study findings: During the first PEs, patients showed more interest in counselling than during refill PEs, as two thirds of the counselling refusals were observed during refill PEs. * Prescriptions that resulted in a pharmaceutical intervention required more counselling than prescriptions without any intervention, because interventions imply to inform the patient about the DRP, and to involve him/her in solving it. Additionally, these prescriptions must involve the pharmacist, who is known to give more counselling than other pharmacy staff member. Provider level
* Pharmacists provided more counselling to customers than other pharmacy staff members. Other studies reported this factor as well [19; 47; 50]. A reason could be that pharmacists have a larger knowledge about drug therapy. Counselling should be driven by the patient and the prescription, not by the randomly allocated pharmacy staff member.