Raising awareness of the benefits in order to make a change in retailers’ occupational activities at pharmacies and drug stores meeting the GPP standard (A before and after intervention

Journal of military pharmaco-medicine no4-2018

RAISING AWARENESS OF THE BENEFITS IN ORDER TO MAKE
A CHANGE IN RETAILERS’ OCCUPATIONAL ACTIVITIES AT
PHARMACIES AND DRUG STORES MEETING THE GPP
STANDARD (A before and after intervention study)
Trinh Hong Minh*; Pham Dinh Luyen*; Phan Van Binh***
SUMMARY
Objectives: To evaluate the results obtained from popularizing retailers’ awareness of
benefits that directly affects their business activities at pharmacies and drug stores with GPP
endorsement. Method: A cross-sectional and semi-empirical intervention (comparison before
and after without a control group). Results: There was a dramatic rise in the appropriate
perception of benefits of implementing right business activities. This rate increased from 34.7%
to 59.1% for pharmacists (5-year training) and from 27.1% to 35.8% for intermediate
pharmacists (2-year training). Since these changes, there have been increases in percentage of
implementation of 06 business activities with the corresponding rates from 33% to 51.4% for
pharmacists and from 27.1% to 39.1% for intermediate pharmacists. Conclusion:
Pharmaceutical retailers’ awareness about the benefits from adequate business activities will
promote retailers’ good performance under GPP standard.
* Keywords: Perception; Benefits; Business activities; Pharmacy; Drug stores; Retailers.

INTRODUCTION
Business activities are basic ones in
the professional practice of pharmacists
and medical staff at pharmacies that meet
GPP (Good Pharmacy Practice) standards
in Vietnam. One of the very first principles
of this standard is to prioritize the profit of
patients and health of the community [1].
In 2014, we conducted a survey on the
reality of drug retailers’ occupational

activities at pharmacies and drug stores in
Dongnai province. The results showed
that their awareness of benefits from right

business activities had a statistically
significant effect on the pharmacy practice
[2]. Therefore, we conducted this study
with a view to: Evaluate the results of
raising awareness of the benefits to make
a change in the occupational activity of
drug retailers at GPP-endorsed pharmacies.
SUBJECTS AND METHODS
1. Subjects.
Drug retailers including pharmacists
and intermediate pharmacists at pharmacies
and drug stores with GPP standards in
Dongnai province.

* Dongnai Medical College
** Hochiminh University of Medicine and Pharmacy
*** Vietnam Military Medical University
Corresponding author: Trinh Hong Minh ()
Date received: 10/02/2018
Date accepted: 23/03/2018

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Journal of military pharmaco-medicine no4-2018
2. Methods.

- Research design: Cross-sectional and semi-empirical interventional studies [3].
The research model is represented by the following symbol: RO1 XO2.
Collecting statistics
(before intervention)

Collecting statistics
(After intervention)

Methods

Comparison and analysis
The result is determined by the formula:
E = O2 - O1.
* Study sample: Use the sample size
formula based on the two-factor comparison
calculating formula and use in the
intervention study design: 60 retailers [4].
* Sampling method: Collecting a sample
of 60 retailers who agreed to participate in
the intervention process out of 180 people
were observed and interviewed (not by
university and intermediate levels; by area).
* Data collecting method: Use observation
checklist and questionnaire.
* Content and method of intervention:
- Direct propaganda: Popularize benefits
to drug retailers in the implementation of
professional activities.
- Organize discussion group to exchange
experiences in occupational activities for

two subjects including pharmacists and
intermediate pharmacists (from 3 to 5 people
each) depending on the area of operation.
* Research indicators:
- Results of perceptions of the benefits
of good performance of occupational
activities of pharmacists and intermediate
pharmacists before and after intervention.
- The results of six occupational activities
of the pharmacists and intermediate
pharmacists before and after intervention.

* Data analysis and processing:
Comparison of pre-test performance Wilcoxon test for quantitative variables
without standard distribution [6]. Comparison
of change results after intervention of two
groups by Chi-squared test [5]. Use
statistical software SPSS 20.0.
* Research sites: At the pharmacies
and drug stores that meet GPP standards
in Dongnai province.
* Time of study: November to December,
2014.
RESULTS AND DISCUSSION
1. Change in retailers’ awareness of
benefits when implementing right
business activities.
Using interview surveys on the drug
retailers’ and their clients’ benefits with
eight questions. Likert score with five grading scales was used: complete

disagreement, disagreement, neutral,
agreement, and complete agreement.
The scales of agreement and complete
agreement illustrate the perception of
benefits from retailers. After conducting a
propaganda, an interview will be done to
evaluate the drug retailers’ awareness of
the advantages of occupational activities.
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Journal of military pharmaco-medicine no4-2018
Table 1: Changes in retailers’ awareness about benefits before and after intervention.

Pharmacists
Benefits

Implementation
of
all
business activities will make
a success of drug retailers
rather than invest in facilities

Implementation
of
regulations
on
selling
medicine without prescription

will help increase turnover
and gain prestige

Making good exchanges of
information about medicine
with patients, retailers can
earn
experience
and
broaden
expertise
to
ameliorate business activities

Instructing clients for medical
examination in particular
situations, retailers should
put patient’s benefits higher
than private profits and build
their trust

Providing
buyers
with
information about drugs to
help retailers to share
professional experience and
enhance
their
business

activities

146

Level

(n = 22)

Wilcoxon
signedRank test

Intermediate
pharmacists
(n = 38)

Before

After

Before

After

1

2

0

8

1

2

5

2

15

11

3

3

1

4

6

4

8

8

10

17

5

4

11

1

3

1

4

2

13

1

2

4

4

10

10

3

7

4

9

9

4

3

5

3

14

5

4

7

3

4

1

6

1

10

7

2

3

4

15

16

3

6

4

5

4

4

5

6

6

9

5

2

7

2

2

1

3

2

6

5

2

6

5

19

20

3

7

5

9

8

4

4

5

3

4

5

2

5

1

1

1

6

1

13

7

2

7

6

11

12

3

4

3

6

5

4

3

6

3

8

5

2

6

5

6

p < 0.05

p < 0.05

p < 0.05

p < 0.05

p < 0.05

Wilcoxon
signedRank test

p < 0.05

p < 0.05

p < 0.05

p > 0.05

p < 0.05


Journal of military pharmaco-medicine no4-2018
Implementation
of

regulations on selling drugs
with prescription increases
the number of clients and
strengthens the relationship
with physicians

1

4

2

8

5

2

8

8

12

15

3

5

5

8

8

4

4

2

8

8

5

1

5

2

2

Ensuring a reasonable price
and publicity of drug prices
will give confidence to the
buyer

and
earn
good
reputation
for
the
establishment

1

0

0

9

2

2

5

3

14

14

3

4

3

3

5

4

9

10

7

12

5

4

6

5

5

The
implementation

of
professional
rules
will
enhance the credibility of the
seller and help the buyers
select
well-qualified
pharmacy

1

4

1

7

1

2

7

2

15

14

p < 0,05

p < 0.05

p < 0.05

3

5

5

9

8

4

2

6

6

11

5

4

8

1

3

p > 0,05

p < 0.05

p < 0.05

After the research, pharmacists had proper awareness of 8 benefits from obeying
the occupational activities (p < 0.05). The approval rate significantly increased by
24.4% (from 34.7% to 59.1%); for intermediate pharmacists, the percentage of
agreement increased by 14.2% (from 21.7% to 35.9%), 6 out of 8 contents showed
significant relevant changes (p < 0.05). The two remaining contents remained
unchanged, that is, the benefits from guiding the drug buyer for medical examination
and selling the prescription drug.
2. Change in bussiness activities.
* Results in selling medicine without prescription in common diseases:
The results of the change in the non-prescription drug sales in common illnesses of
the pharmacists and intermediate pharmacists.
Table 2: Change in the non-prescription drug sales in common illnesses before after intervention.
Pharmacists
(n = 22)
Activities

Before

Intermediate pharmacists
(n = 38)

After

Before

After

Yes

No

Yes

No

Yes

No

Yes

No

18

4

22

0

30

8

38

0

Asking patients’ information: sex, age

19

3

22

0

21

17

38

0

Other diseases

18

4

22

0

17

21

38

0

Finding out information about disease’s
syndromes
Collecting information about drug users:

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Journal of military pharmaco-medicine no4-2018
Giving advice and inform drug buyers the following contents:
Exchange the buyer to choose the
suitebale medicine and proper finance

0

22

4

Instructions
Provide the buyer with general information
of drug (side effects, drug interactions...)

20

2

5

17

Record notes for non-packaged medicine

3

Implement regulations on selling antibiotics

0

Keep patients’ information after selling drugs

0

Total

Percentage

18

0

38

0

22

0

10

12

19

12

22

4

22

0

38

32

6

33

5

1

37

4

34

10

0

38

3

35

18

0

38

0

38

22

0

38

0

38

83

115

118

80

101

241

154

188

41.9

58.1

59.6

40.4

29.5

70.5

45.0

55.0

After the research, the results of the sale of non-prescription drugs in the common
disease showed a statistically significant change for pharmacist bachelors
(improvement from 41.9% to 59.6%); for intermediate pharmacists trainers, the
proportion showed the same upward trend from 29.5% to 45%. However, there was a
tiny change or nearly stable in business activities such as exchanging with buyers to
determine appropriate treatment drug and financial ability or selling antibiotics and
keeping patient’s information.
2. The results of non-prescription drug sale in pathologies that must be
diagnosed by the physician.
For diseases that require physician’s diagnosis, retailers must refuse to sell drugs

and advise drug buyers to visit the doctor. Changes in this activity before and after
research treatment are shown in figure 1.

Figure 1: The percentage of refusal in selling drugs of disease requiring the diagnosis
of the physician before - after intervention.
After the research, the results of selling medicine with physician’s diagnosis and no
prescription drugs changed significantly among pharmacists, the rate of refusal to sell
drug and instruction patients for medical examination increased from 31.8% to 50%.
These rates increased from 15.8% to 26.4% for intermediate pharmacists, this result
was not statistically significant.
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Journal of military pharmaco-medicine no4-2018
3. Results of selling drugs with prescription.
Table 3: The results of changes in selling drugs with prescription before - after intervention.
Pharmacists
(n = 22)

Activities

Before

Intermediate pharmacists
(n = 38)

After

Before

After

Yes

No

Yes

No

Yes

No

Yes

No

Check prescriptions before selling
(detect errors)

0

22

7

15

0

38

4

34

Give instructions on how to use and
remind buyers to follow strictly the
prescription

8

14

21

1

23

15

38

0

Check and compare prescription to
drugs sold before giving them to the
buyers

18

4

20

2

33

5

38

0

Give the right medicine as prescription
Sell drugs similar to the ones in the
prescription must consult the buyer
Sell another drug in the name of the
drug but the same ingredients

20
-

2
2

1

-

1
1

29
0

9
9

31
-

7
7

1

1

-

0

1

8

1

6

Record drug information for follow-up

0

22

0

22

0

38

0

38

Total
Percentage

47

67

70

42

86

122

112

92

41.2

58.8

62.5

37.5

41.3

58.7

54.9

45.1

After the research, the results of the sale of prescription drugs had a statistically
significant change for the university pharmacists (the rate of correct implementation
increased from 41.2% to 62.5%); for intermediate pharmacists, these rates increased
from 41.3% to 54.9%. However, the activity of recording drug information for follow-up

did not change before and after research.
4. Results of selling medicines at fixed prices.

Figure 2: Results of selling medicines at fixed prices before - after intervention.
After research, the results of the implementation of selling drugs at fixed prices of
pharmacist have changed, rising up from 40.9% to 54.5%; however, this change does
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Journal of military pharmaco-medicine no4-2018
not statistically make sense. For intermediate pharmacists, these rates increased from
36.8% to 57.9%, in this case, the results changed significantly.
5. The results of drug packaging process.
The differences before and after research in following drug packaging regulation of
pharmacist and intermediate pharmacists are illustrated in table 4.
Table 4: Results of following drug packaging regulation before - after intervention.
Pharmacists

Intermediate pharmacists

(n = 22)

(n = 38)

Activities
Before

After

Before

After

Yes

No

Yes

No

Yes

No

Yes

No

Comply with packaging regulations for
drugs used outside

0

22

0

22

0

38

0

38

Follow sealed packaging process for
drugs that cannot be touched directly

3

19

16

6

1

37

9

29

3

41

16

28

1

75

9

67

6.8

93.2

36.4

63.6

1.3

98.7

11.8

88.2

Total

Percentage

After the research, the results of the implementation of drug packages among the
pharmacists bachelors had a statistically significant change, rocketed from 6.8% to
36.4%. For intermediate pharmacists, the rate of right implementation rose from 1.3%
to 11.8%, the results also changed significantly. Despite the change, the results are
rather low, which meant that drug packaging has not yet received much attention of
drug retailers.
6. Results of other professional activities.
The changes in other professional activities among pharmacists and intermediate
pharmacists are presented in table 5.
Table 5: Results of other professional activities before - after intervention.

Activities

Pharmacists

Intermediate pharmacists

(n = 22)

(n = 38)

Before

After

Before

After

Yes

No

Yes

No

Yes

No

Yes

No

Wearing uniform

19

3

22

0

33

5

34

4

Wearing badge

0

22

1

21

0

38

0

38

At workplace

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Journal of military pharmaco-medicine no4-2018
Temperature and humidity control

0

Temperature (< 30 C)

1

21

5

17

1

37

1

37

Humidity (< 75%)

19

3

22

0

38

0

38

0

0

22

0

22

0

38

0

38

Arrange medicine based on the
preservation conditions on the label
Total
Percentage

39

71

50

60

72

118

73

117

35.5

64.5

45.5

54.5

37.9

62.1

38.4

61.6

After research, the results of some other professional activities among pharmacists
have changed from 35.5% to 45.5%, which is statistically significant; for intermediate
pharmacists, the proportion of implementation increased from 37.9% to 38.4%, this
change not statistically significant. Two completely unchanged activities before and
after research are wearing badge at workplace and arranging medicine based on the
preservation conditions stated on the label.
CONCLUSIONS AND
RECOMMENDATIONS
By direct propaganda and discussion
group, pharmacists are supposed to
enhance their awareness during the
performance of business activities.
Conducting a re-evaluation after the
research showed that there was a
significant change in perception of
retailers, the rate of awareness of the
benefits received among the pharmacists
increased from 34.7% to 59.1% (up
24.4%), and that of the intermediate
pharmacists increased from 21.7% to
35.8% (by 14.2%). Through the change in
perception, there was a change in the rate
of implementation of 06 occupational
activities, this rate increased from 33% to
51.4% (by 18.4%) for pharmacists and
from 27.1% to 39.1% (by 12%) for the
intermediate pharmacists. The comparison
between the two groups of retailers was
statistically significant.

Nevertheless, this change is still low.
Hence, we think it is necessary to develop
a comprehensive intervention that coordinates the propaganda of the benefits
of right business activities with the state’s

management. The drug retailers are
encouraged to increase the management
competence, make the most of drug users
to stimulate drug retailer activities, ensure
the sustainability of the intervention.
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