Pharmacist supply of non-prescription sildenafil in Norway: a simulated patient mixed-method study

Abstract Background Pharmacist supply of non-prescription sildenafil was initiated in Norway in 2019, and continuous evaluation of the service is warranted. Objectives To map how the service checklist is used, evaluate the counselling and information given in consultations, get an insight into pharmacist assessments during consultations, and explore the pharmacists’ experiences with the service. Methods A mixed-method approach of simulated patient visits with feedback combined with qualitative interviews was used. One 24-year-old simulated patient visited pharmacies requesting sildenafil in a scenario that ended before purchase. Visits were audio-recorded and evaluated. Post-visit, pharmacists were invited to get feedback and participate in an audio-recorded interview. Visits, feedback, and interviews were transcribed and analysed by descriptive statistics and systematic text condensation. Key findings Of 39 visits, 26 were analysed and 13 were excluded because the pharmacists did not give consent. Six (23%) pharmacists asked all the checklist questions, while 15 (58%) asked some of them. None of the pharmacists provided all the guideline counselling points. The counselling most provided was ‘See your general practitioner within 6 months for a health check’ (N = 7, 27%). Interviews (N = 19) elicited that pharmacists assessed the patients, with adaptations in the use of the checklist. Several barriers affecting the service were identified, including time pressure, pharmacist competence, and the task being uncomfortable and challenging. Conclusions Most pharmacists did not completely adhere to the mandatory checklist on non-prescription sildenafil and the counselling and information given were limited. The pharmacy sector must increase awareness of how best to assess and manage patients requesting non-prescription sildenafil.