Abstract：
BACKGROUND: In Germany, over-the-counter (OTC) medicines may only be dispensed by community pharmacies (CPs). German CPs must ensure \'adequate\' counselling, including the cost of medicines. Along with information gathering and advice giving as classic aspects of counselling, the aim was also to investigate counselling indicators of product and price transparency.
METHODS: The cross-sectional study was based on the covert simulated patient (SP) methodology and was conducted in a random sample of CPs stratified by districts in the major German city of Munich. Each of the 178 selected CPs was visited once by one of five trained female students. They simulated a symptom-based sub-scenario 1 with a request for an OTC medicine for a headache and a sub-scenario 2 with standardised information regarding product and price transparency. The assessment, completed immediately postvisit by the SPs, included a total of 23 items.
RESULTS: All 178 scheduled visits were completed successfully. The median counselling score with the classic items was 3.0 out of 12 points (interquartile range [IQR] 4.25) and when expanded by items for product and price transparency the score was 4.0 out of 14 points (IQR 4.00). A selection of medicines was offered unsolicited in 38.2% of the visits and in 5.6% of the visits voluntary price information was provided before the transaction. A request for a cheaper medicine led to a significant price reduction (Wilcoxon signed-rank test; p < 0.001, r = 0.869).
CONCLUSIONS: Due to the below-average level of counselling, the regional chambers of pharmacists are recommended to initiate measures for improvement. There is also potential for optimisation with regard to product and price transparency as an important extension of the classic counselling aspects. It is therefore recommended that the government raise customers\' awareness of the cost of medicines.
METHODS: The cross-sectional study was based on the covert simulated patient (SP) methodology and was conducted in a random sample of CPs stratified by districts in the major German city of Munich. Each of the 178 selected CPs was visited once by one of five trained female students. They simulated a symptom-based sub-scenario 1 with a request for an OTC medicine for a headache and a sub-scenario 2 with standardised information regarding product and price transparency. The assessment, completed immediately postvisit by the SPs, included a total of 23 items.
RESULTS: All 178 scheduled visits were completed successfully. The median counselling score with the classic items was 3.0 out of 12 points (interquartile range [IQR] 4.25) and when expanded by items for product and price transparency the score was 4.0 out of 14 points (IQR 4.00). A selection of medicines was offered unsolicited in 38.2% of the visits and in 5.6% of the visits voluntary price information was provided before the transaction. A request for a cheaper medicine led to a significant price reduction (Wilcoxon signed-rank test; p < 0.001, r = 0.869).
CONCLUSIONS: Due to the below-average level of counselling, the regional chambers of pharmacists are recommended to initiate measures for improvement. There is also potential for optimisation with regard to product and price transparency as an important extension of the classic counselling aspects. It is therefore recommended that the government raise customers\' awareness of the cost of medicines.
摘要：
背景：在德国，非处方药(OTC)只能由社区药房(CP)发放。德国CP必须确保“足够的”咨询，包括药品的费用。除了信息收集和咨询作为咨询的经典方面，目的还在于调查产品和价格透明度的咨询指标。
方法：横断面研究基于秘密模拟患者（SP）方法，并在德国主要城市慕尼黑按地区分层的随机抽取样本中进行。178名选定的注册会计师中的每一个都由五名受过训练的女学生之一访问了一次。他们模拟了一个基于症状的子场景1，其中要求使用OTC药物治疗头痛，以及一个子场景2，其中包含有关产品和价格透明度的标准化信息。评估,SP在访问后立即完成，共包括23个项目。
结果：所有178次预定访视均顺利完成。经典项目的咨询得分中位数为12分中的3.0分（四分位数范围[IQR]4.25），按产品和价格透明度的项目扩展时，得分为14分中的4.0分（IQR4.00）。在38.2％的访问中主动提供了精选药物，在5.6％的访问中，自愿价格信息是在交易前提供的。对廉价药物的要求导致价格显着降低（Wilcoxon符号秩检验；p<0.001，r=0.869）。
结论：由于咨询水平低于平均水平，建议区域药剂师商会采取改进措施。在产品和价格透明度方面也有可能进行优化，这是经典咨询方面的重要延伸。因此，建议政府提高消费者对药品成本的认识。
方法：横断面研究基于秘密模拟患者（SP）方法，并在德国主要城市慕尼黑按地区分层的随机抽取样本中进行。178名选定的注册会计师中的每一个都由五名受过训练的女学生之一访问了一次。他们模拟了一个基于症状的子场景1，其中要求使用OTC药物治疗头痛，以及一个子场景2，其中包含有关产品和价格透明度的标准化信息。评估,SP在访问后立即完成，共包括23个项目。
结果：所有178次预定访视均顺利完成。经典项目的咨询得分中位数为12分中的3.0分（四分位数范围[IQR]4.25），按产品和价格透明度的项目扩展时，得分为14分中的4.0分（IQR4.00）。在38.2％的访问中主动提供了精选药物，在5.6％的访问中，自愿价格信息是在交易前提供的。对廉价药物的要求导致价格显着降低（Wilcoxon符号秩检验；p<0.001，r=0.869）。
结论：由于咨询水平低于平均水平，建议区域药剂师商会采取改进措施。在产品和价格透明度方面也有可能进行优化，这是经典咨询方面的重要延伸。因此，建议政府提高消费者对药品成本的认识。
