title: Provision of primary care to patients with chronic cough in the community pharmacy setting.
abstract: BACKGROUND
  Community pharmacies are at the forefront of primary care providers and have an important role in the referral of patients to a medical practitioner for review when necessary. Chronic cough is a common disorder in the community and requires medical assessment. The proficiency of community pharmacy staff to refer patients with chronic cough is currently unknown.
  
  
  OBJECTIVE
  To assess the ability of community pharmacy staff to recognize and medically refer patients with a chronic nonproductive cough.
  
  
  METHODS
  Following ethics approval, a simulated patient study of 156 community pharmacies in Perth, Western Australia, was conducted over a 3-month period. Simulated patients presented to the pharmacy requesting treatment for a cough. The simulated patient required a referral based on a designated scenario. Demographic details, assessment questions, and advice provided were recorded by the simulated patient immediately postvisit. A logistic regression analysis was performed, with referral for medical assessment as the dependent variable.
  
  
  RESULTS
  Of the 155 community pharmacies included in the analysis, 38% provided appropriate medical referral. Cough suppressants were provided as therapy in 72% of all visits. Predictors of medical referral were assessment of symptom duration, medical history, current medications being taken, frequency of reliever use, and the position of the pharmacy staff member conducting the consultation. A third of community pharmacies provided appropriate primary care by recommending medical referral advice to patients with chronic cough. The majority of pharmacy staff members acquired information from the patient that suggested a need for medical referral, yet did not provide referral advice.
  
  
  CONCLUSIONS
  Appropriate medical referral is more likely when adequate assessment is undertaken and when a pharmacist is directly involved in the consultation. This highlights the need for pharmacies to ensure that processes are in place for patients to access the pharmacist.
authors.affiliation: School of Biomedical, Biomolecular and Chemical Sciences, The University of Western Australia, Crawley, Australia. c.r.schneider@aston.ac.uk
authors.forename: Carl R
authors.initials: CR
authors.lastname: Schneider
authors.forename: Alan W
authors.initials: AW
authors.lastname: Everett
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Geelhoed
authors.forename: Peter A
authors.initials: PA
authors.lastname: Kendall
authors.forename: Kevin
authors.initials: K
authors.lastname: Murray
authors.forename: Peter
authors.initials: P
authors.lastname: Garnett
authors.forename: Mariam
authors.initials: M
authors.lastname: Salama
authors.forename: Rhonda M
authors.initials: RM
authors.lastname: Clifford
mesh_terms: D002908:Chronic Disease; D003157:Community Pharmacy Services; D003371:Cough / Q000188:drug therapy*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D016544:Patient Simulation; D010594:Pharmacies; D010595:Pharmacists; D011320:Primary Health Care; D012017:Referral and Consultation; D014904:Western Australia