# Dispensing of Prescribed Medicines in Swiss Community Pharmacies-Observed Counselling Activities
## 2 Materials and Methods
### Data Collection  
Community pharmacies in Basel, Switzerland, were randomly invited for study participation, according to a prior study [19]. One master student in pharmacy observed pharmacy staff-customer interactions for one day at each participating community pharmacy in a non-participatory way during March and April 2016. The observation method was based on ad-hoc manual recording of exchanged information during a pharmacy staff-customer interaction and subsequent transcribing into quantitative information. After a quick briefing about the study, the pharmacy staff were neither actively involved in data collection, nor disturbed in their usual practice. At the dispensing of prescribed medicines, counselling content (information exchanged over the counter between customer and pharmacy staff), patient characteristics (e.g., age), pharmaceutical interventions (e.g., dose adjustment) and additional activities (offered and/or performed further activity/service) were documented on a structured checklist for each prescription encounter (PE). The non-participatory observer stood next to a pharmacy staff member and recorded a PE from the greeting of a customer (patient or career) filling a prescription in the community pharmacy to closing salutations; where after, the next customer was observed. Customers were not informed about the study to avoid any influence on the counselling activities. Only communication in German was assessed.  
The checklist was modified from a previous study [20] and enabled ad hoc coding of nine categories and 61 predefined themes: Patient characteristics (n = 4 themes), provider (pharmacy staff involved, n = 1), prescription (n = 7), counselling (n = 34), intervention (n = 2), physician contact (n = 2), situation (n = 6), and additional activities (n = 5). The category counselling, including 34 counselling themes that were considered as best practice, was derived from the 'drug check' of the Swiss service-based remuneration system [13], the literature [9; 21; 22], the requirement of the Omnibus Budget Reconciliation Act (OBRA, 1990) [23], the recommendations for internal audits of the Swiss Pharmacists' Association [24], and on expert discussions with five community pharmacists. Each theme was defined in a data dictionary to standardize the observer judgement. The checklist enabled to distinguish between the active and passive (e.g., asking and answering questions, respectively) involvement of the pharmacy staff and the customer during the PEs. After piloting, the checklist was refined and cases were discussed between the observer and two experienced community pharmacists to ensure data quality. An anonymized copy of the prescription and list of medicines from refill prescriptions of every observed patient were additionally collected and used to test the documentation of the observed PEs on consistency and plausibility. Observation time and characteristics of the pharmacies and their staff were recorded separately.  
The systematic documentation of the pharmaceutical interventions, performed by pharmacists, were accomplished with aid of the Pharmacists' Documentation of Intervention in Seamless Care (PharmDISC) system. This classified the pharmaceutical interventions in different categories (problem, type of problem, cause, intervention, person involved, and the outcome of the intervention) [25].  
At the end of the observation day, a semi-structured interview focusing the pharmacists' opinion on the counselling, triggers, facilitators, and barriers was conducted with one pharmacist per pharmacy. The results of the interviews are reported separately [26].  
The main outcome measures were the number and type of themes covered in counselling, the factors influencing counselling provision, and number, frequency, and type of pharmaceutical interventions and additional activities.