# Dispensing of Prescribed Medicines in Swiss Community Pharmacies-Observed Counselling Activities
## 4 Discussion
### Counselling  
Counselling was provided to 66.0% of the customers receiving prescribed medicines, which is slightly more than in a previous observation study (57.3%) performed in Switzerland in 2010 [19]. A review of worldwide counselling practices on prescribed medicines reported counselling rates from 12% to 100%, when observational methods were used [17]. In this study, the customers were counselled on up to 13 out of the 34 predefined counselling themes per PE. However, in real daily practice, 34 different themes cannot be counselled at one PE, as this would overload the patient. Staff members \begin{table}
\begin{tabular}{c c c c} \hline \hline
**Intervention** & **Cause of Intervention** & **Type of Problem** & **n (\%)** \\ \hline
**Total interventions** & & & **203 (100.0)** \\  & **Technical** & & 180 (88.7) \\ Clarification/addition of information & Incomplete/unclear prescription & Manifest, reactive & 55 (27.1) \\ Substitution (generic) & Financial burden & Manifest, reactive & 49 (24.1) \\ Substitution & Prescribed drug not available & Manifest, reactive & 31 (15.3) \\ Adjustment of package size/quantity & Financial burden & Manifest, reactive & 18 (8.9) \\ Adjustment of package size/quantity & Financial burden & Manifest, reactive & 9 (4.4) \\  & **Clinical** & & 23 (11.3) \\ Adjustment of package size/quantity & Concerns about the treatment & Manifest, reactive & 3 (1.5) \\ Substitution & No concordance with guidelines, only suboptimal therapy possible & Potential, preventive & 2 (1) \\ Substitution & Concerns about the treatment & Manifest, reactive & 2 (1) \\ Therapy stopped/no delivery & Drug-drug interaction & Potential, preventive & 2 (1) \\ In-depth counselling of patient & Drug-drug interaction & Potential, preventive & 2 (1) \\ \hline \hline \end{tabular}
\end{table} 
Table 4: The most frequently observed pharmaceutical interventions, their cause and type of problem (documented with the PharmDISC system). have to decide on priorities during the interaction with the patient. With refill prescriptions, additional themes can be counselled at following visits. Written information in the form of an individualized label to reinforce verbal communication was provided in 43% of the PEs. A quarter of customers refused counselling and one-third of the customers did not receive any counselling. The study design did not take into account the long-term relationship between the pharmacy staff and the patient as a regular customer, with pre-existing counselling provided at a prior PE, which could lead to PEs without observed counselling. This is in line with what was observed previously: New customers received more counselling than regular customers. Nevertheless, this study depicted how the patient received the counselling at the counter. The findings revealed that pharmacists were involved in direct patient contact at the counter in only a quarter of all PEs. Pharmacists' activities, such as drug interaction-check and investigating medication history, have often been done in the back office, and are neither visible, nor communicated to the customer. If pharmacy staff were more transparent and better communicated their activities to the customer during dispensing, this could improve trust and collaboration. The themes of counselling were more product-centered (e.g., dose, administration) than patient-centered (e.g., adherence, therapy benefit), similar to the findings of other studies [17; 19; 27]. Indeed, the counselling patterns of Figure 2 illustrate the gaps in patient-centered counselling. Especially for patients refilling prescribed medicines, low counselling ratios were observed. Not addressing the patient-centered counselling themes at refill might be interpreted as a missed opportunity to improve patients' adherence to their drug therapy. It is known that patients often stop taking their newly prescribed medicines in the first months of therapy (medication non-persistence), because of concerns (e.g., adverse effect) and lack of perceived need (e.g., poor understanding of medicines/disease) [28; 29].