The influence of generic substitution on the content of patient-pharmacist communication in Swedish community pharmacies

摘要

Objectives The objective was to study the relationship between the length and content of patient-pharmacist communication in community pharmacies, and generic substitution.Methods The study was conducted in six community pharmacies in Sweden. Non-participant observations with audio recordings and short structured interviews were conducted. Out of 32 pharmacists 29 agreed to participate (90.6%), as did 282 out of 407 patients (69.3%). Logistic regression analysis was applied to calculate odds ratio for occurrence of generic substitution. Linear regression (p-coefficients) was applied to test for differences in time spent on different categories.Key findings In encounters where generic substitution occurred more time (19.2 s) was spent on non-medical (for instance administrative or economical) issues (P = 0.01, 95% confidence interval 4.8-33.6). However, the total time of the encounter was not significantly longer. The amount of time spent on non-medical issues increased with age of patient (age 60+: (3, 33 s, P < 0.001). The results indicate that more time was spent on medical issues with patients who have a higher education (high school: (3, 10.8 s, P = 0.07, university: beta, 10.2 s, P = 0.11) relative to those with only elementary school education. Conclusions Occurrence of generic substitution was correlated with more time spent on communicating on non-medical, but not on medical, issues. No extra time was spent on medical information for the groups normally overrepre-sented among those with low health literacy. This study suggests that pharmacists need to further embrace their role in promoting rational use of medicines, not least when generic substitution occurs.