Measuring the assessment and counseling provided with the supply of nonprescription asthma reliever medication: a simulated patient study

Ann Pharmacother. 2009 Sep;43(9):1512-8. doi: 10.1345/aph.1M086. Epub 2009 Aug 18.


Background: Over one quarter of asthma reliever medications are provided without prescription by community pharmacies in Australia. Evidence that community pharmacies provide these medications with sufficient patient assessment and medication counseling to ensure compliance with the government's Quality Use of Medicines principles is currently lacking.

Objective: To assess current practice when asthma reliever medication is provided in the community pharmacy setting and to identify factors that correlate with assessment of asthma control.

Methods: Researchers posing as patients visited a sample of Perth metropolitan community pharmacies in May 2007. During the visit, the simulated patient enacted a standardized scenario of someone with moderately controlled asthma who wished to purchase a salbutamol (albuterol) inhaler without prescription. Results of the encounter were recorded immediately after the visit. Regression analysis was performed, with medication use frequency (a marker of asthma control) as the dependent variable.

Results: One hundred sixty community pharmacies in the Perth metropolitan area were visited in May 2007. Pharmacists and/or pharmacy assistants provided some form of assessment in 84% of the visits. Counseling was provided to the simulated patients in 24% of the visits. Only 4 pharmacy staff members asked whether the simulated patient knew how to use the inhaler. Significant correlation was found between assessment and/or counseling of reliever use frequency and 3 independent variables: visit length (p < 0.001), number of assessment questions asked (p < 0.001), and the simulated patient who conducted the visit (p < 0.02).

Conclusions: Both patient assessment and medication counseling were suboptimal compared with recommended practice when nonprescription asthma reliever medication was supplied in the community pharmacy setting. Pharmacy and pharmacist demographic variables do not appear to affect assessment of asthma control. This research indicates the need for substantial improvements in practice in order to provide reliever medication in line with Quality Use of Medication principles of ensuring safe and effective use of medication.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Inhalation
  • Adult
  • Albuterol / administration & dosage
  • Albuterol / therapeutic use
  • Anti-Asthmatic Agents / administration & dosage
  • Anti-Asthmatic Agents / therapeutic use*
  • Asthma / drug therapy*
  • Bronchodilator Agents / administration & dosage
  • Bronchodilator Agents / therapeutic use
  • Community Pharmacy Services / standards*
  • Directive Counseling / standards
  • Female
  • Humans
  • Male
  • Middle Aged
  • Nebulizers and Vaporizers
  • Nonprescription Drugs / administration & dosage
  • Nonprescription Drugs / therapeutic use
  • Patient Education as Topic / standards
  • Patient Simulation
  • Pharmacists / organization & administration
  • Pharmacists / standards*
  • Regression Analysis
  • Western Australia
  • Young Adult


  • Anti-Asthmatic Agents
  • Bronchodilator Agents
  • Nonprescription Drugs
  • Albuterol