Pharmacy World & Science

, Volume 32, Issue 4, pp 455–463 | Cite as

Counselling behaviour and content in a pharmaceutical care service in Swedish community pharmacies

  • Anna T. MontgomeryEmail author
  • Åsa Kettis Lindblad
  • Pernilla Eddby
  • Emelie Söderlund
  • Mary P. Tully
  • Sofia Kälvemark Sporrong
Research Article


Objective To characterise the counselling behaviour of practitioners providing a pharmaceutical care (PC) service in community pharmacy, and to describe the content of the consultations. Setting Community pharmacies in Sweden. Methods Non-participant observations, including audio recording, of five practitioners in five different pharmacies counselling 16 patients, were analysed qualitatively using an iterative, stepwise, interpretivist approach. Main outcome measure Descriptions of counselling behaviour and content of consultations. Results The counselling behaviour was characterised by attempts to understand the patients’ narratives by listening and asking questions and a willingness to help. The computer often had an important role in consultations, being used for documentation and as a supportive tool for identification of drug–drug interactions. The practitioners often took command in the initial phase of the consultation, and omitted to determine the patients’ most urgent drug-related needs. However, counselling behaviour that identified and focused on the patient’s needs, giving the computer little attention during the consultation was also observed. Practitioners provided vague descriptions of the purpose and outline of the service. Consultations included a wide variety of issues, which potentially could help patients’ achieve optimal outcomes of medical treatment. Conclusion The practitioners provided important advice and different forms of support to patients. Focus on the computer screen limited their abilities to practise patient centred care.


Community pharmacy Observational study Pharmaceutical care Pharmacist consultations Qualitative research Sweden 



We thank the practitioners who were willing to be observed in their daily work and the patients whose consultations were observed.


This study was funded by Apoteket AB. The funding received did not in any way impact on the study design or the interpretations of the results.

Conflicts of interest

Two of the authors; Anna Montgomery and Sofia Kälvemark Sporrong, were employed by Apoteket AB when the study was carried out. They were not involved in the provision of the pharmaceutical care service in any community pharmacy.


  1. 1.
    Cipolle RJ, Strand LM, Moreley PC. Pharmaceutical care practice—the clinician’s guide. 2nd ed. New York: McGraw-Hill Companies Inc; 2004.Google Scholar
  2. 2.
    Little P, Everitt H, Williamson I, Warner G, Moore M, Gould C, Ferrier K, Payne S. Preferences of patients for patient centred approach to consultation in primary care: observational study. BMJ. 2001;322:468–72.CrossRefPubMedGoogle Scholar
  3. 3.
    Kinnersley P, Stott N, Peters TJ, Harvey I. The patient-centredness of consultations and outcome in primary care. Br J Gen Pract. 1999;49:711–6.PubMedGoogle Scholar
  4. 4.
    Stewart M. Towards a global definition of patient centred care. BMJ. 2001;322:444–5.CrossRefPubMedGoogle Scholar
  5. 5.
    Bultman DC, Svarstad BL. Effects of physician communication style on client medication beliefs and adherence with antidepressant treatment. Patient Educ Couns. 2000;40:173–85.CrossRefPubMedGoogle Scholar
  6. 6.
    Bultman DC, Svarstad BL. Effects of pharmacist monitoring on patient satisfaction with antidepressant medication therapy. J Am Pharm Assoc (Wash). 2002;42:36–43.CrossRefGoogle Scholar
  7. 7.
    Murawski MM, Miederhoff PA. Pharmaceteutical caring. Am J Pharm Educ. 1994;58:310–5.Google Scholar
  8. 8.
    Cronqvist A, Theorell T, Burns T, Lutzen K. Caring about—caring for: moral obligations and work responsibilities in intensive care nursing. Nurs Ethics. 2004;11:63–76.CrossRefPubMedGoogle Scholar
  9. 9.
    Fjortoft N. Identifying caring behaviors of pharmacists through observations and interviews. J Am Pharm Assoc. 2006;46:582–8.CrossRefGoogle Scholar
  10. 10.
    Galt K. The need to define “care” in pharmaceutical care: an examination across research, practice and education. Am J Pharm Educ. 2000;64:223–33.Google Scholar
  11. 11.
    Mangiapane S, Schulz M, Muhlig S, Ihle P, Schubert I, Waldmann HC. Community pharmacy-based pharmaceutical care for asthma patients. Ann Pharmacother. 2005;39:1817–22.CrossRefPubMedGoogle Scholar
  12. 12.
    Herborg H, Soendergaard B, Froekjaer B, Fonnesbaek L, Jorgensen T, Hepler CD, Grainger-Rousseau TJ, Ersboell BK. Improving drug therapy for patients with asthma—Part 1: patient outcomes. J Am Pharm Assoc (Wash). 2001;41:539–50.Google Scholar
  13. 13.
    Vrijens B, Belmans A, Matthys K, de Klerk E, Lesaffre E. Effect of intervention through a pharmaceutical care program on patient adherence with prescribed once-daily atorvastatin. Pharmacoepidemiol Drug Saf. 2006;15:115–21.CrossRefPubMedGoogle Scholar
  14. 14.
    Tsuyuki RT, Johnson JA, Teo KK, Simpson SH, Ackman ML, Biggs RS, Cave A, Chang WC, Dzavik V, Farris KB, Galvin D, Semchuk W, Taylor JG. A randomized trial of the effect of community pharmacist intervention on cholesterol risk management: the Study of Cardiovascular Risk Intervention by Pharmacists (SCRIP). Arch Intern Med. 2002;162:1149–55.CrossRefPubMedGoogle Scholar
  15. 15.
    Krass I, Armour CL, Mitchell B, Brillant M, Dienaar R, Hughes J, Lau P, Peterson G, Stewart K, Taylor S, Wilkinson J. The Pharmacy Diabetes Care Program: assessment of a community pharmacy diabetes service model in Australia. Diabet Med. 2007;24:677–83.CrossRefPubMedGoogle Scholar
  16. 16.
    Shah B, Chewning B. Conceptualizing and measuring pharmacist–patient communication: a review of published studies. Res Soc Adm Pharm. 2006;2:153–85.Google Scholar
  17. 17.
    Hargie ODW, Morrow NC, Woodman C. Pharmacists’ evaluation of key communication skills in practice. Patient Educ Couns. 2000;39:61–70.CrossRefPubMedGoogle Scholar
  18. 18.
    Apoteket AB. Accessed 9 Dec 2009.
  19. 19.
    Smith F. Research methods in pharmacy practice. London: Pharmaceutical Press; 2002.Google Scholar
  20. 20.
    Hill CE, Thompson BJ, Williams EN. A guide to conducting consensual qualitative research. Couns Psychol. 1997;25:517–72.CrossRefGoogle Scholar
  21. 21.
    Mays N, Pope C. Qualitative research: observational methods in health care settings. BMJ. 1995;311:182–4.PubMedGoogle Scholar
  22. 22.
    Greatbatch D, Heath C, Campion P, Luff P. How do desk-top computers affect the doctor–patient interaction? Fam Pract. 1995;12:32–6.CrossRefPubMedGoogle Scholar
  23. 23.
    Britten N, Stevenson FA, Barry CA, Barber N, Bradley CP. Misunderstandings in prescribing decisions in general practice: qualitative study. BMJ. 2000;320:484–8.CrossRefPubMedGoogle Scholar
  24. 24.
    Renberg T, Kettis-Lindblad A, Tully MP. Exploring subjective outcomes perceived by patients receiving a pharmaceutical care service. Res Soc Adm Pharm. 2006;2:212–31.Google Scholar
  25. 25.
    Farris KB, Schopflocher DP. Between intention and behavior: an application of community pharmacists’ assessment of pharmaceutical care. Soc Sci Med. 1999;49:55–66.CrossRefPubMedGoogle Scholar
  26. 26.
    Worley-Louis MM, Schommer JC, Finnegan JR. Construct identification and measure development for investigating pharmacist–patient relationships. Patient Educ Couns. 2003;51:229–38.CrossRefPubMedGoogle Scholar
  27. 27.
    Austin Z, Gregory PA, Martin JC. Characterizing the professional relationships of community pharmacists. Res Soc Adm Pharm. 2006;2:533–46.Google Scholar
  28. 28.
    Ojasalo J. Managing customers expectations in professional services. Manag Serv Qual. 2001;11:200–12.CrossRefGoogle Scholar
  29. 29.
    Worley MM, Schommer JC, Brown LM, Hadsall RS, Ranelli PL, Stratton TP, Uden DL. Pharmacists’ and patients’ roles in the pharmacist–patient relationship: are pharmacists and patients reading from the same relationship script? Res Soc Adm Pharm. 2007;3:47–69.Google Scholar
  30. 30.
    Montgomery AT, Kalvemark-Sporrong S, Tully MP, Kettis-Lindblad A. Follow-up of patients receiving a pharmaceutical care service in Sweden. J Clin Pharm Ther. 2008;33:653–62.CrossRefPubMedGoogle Scholar
  31. 31.
    Montgomery AT, Kalvemark-Sporrong S, Manap N, Tully MP, Kettis-Lindblad A. Receiving a pharmaceutical care service compared to receiving standard pharmacy service in Sweden—how do patients differ with regard to perceptions of medicine use and the pharmacy encounter? Res Soc Adm Pharm 2010 (in press). Available online.Google Scholar
  32. 32.
    Nickman NA. (Re-)learning to care: use of service-learning as an early professionalization experience. Am J Pharm Educ. 1998;62:380–7.Google Scholar

Copyright information

© Springer Science+Business Media B.V. 2010

Authors and Affiliations

  • Anna T. Montgomery
    • 1
    • 2
    Email author
  • Åsa Kettis Lindblad
    • 1
    • 3
  • Pernilla Eddby
    • 1
  • Emelie Söderlund
    • 1
  • Mary P. Tully
    • 1
    • 4
  • Sofia Kälvemark Sporrong
    • 1
    • 2
    • 5
  1. 1.Department of PharmacyUppsala UniversityUppsalaSweden
  2. 2.Apoteket ABStockholmSweden
  3. 3.Quality and Evaluation UnitUppsala UniversityUppsalaSweden
  4. 4.School of Pharmacy and Pharmaceutical SciencesUniversity of ManchesterManchesterUK
  5. 5.Department of Public Health and Caring SciencesUppsala UniversityUppsalaSweden

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