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The Pharmaceutical Journal Vol 265 No 7114 September 16, 2000
Pharmacy Practice Research
Papers presented at the British Pharmaceutical Conference, Birmingham, September 10 to 13, 2000 pR43

Views about the treatment of vaginal symptoms in community pharmacies

By M. C. Watson, A. E. Walker and C. M. Bond

Introduction Vulvovaginal candidiasis (VVC), or vaginal thrush, affects 75 per cent of pre-menopausal women.1 Since 1992, a number of antifungal preparations have been reclassified from POM (prescription only medicine) to P (pharmacy only medicine) status.2 As a result, a woman is able to seek immediate relief from her symptoms rather than having to wait for an appointment with her general practitioner. There has been little evaluation of community pharmacists' beliefs and views about their role in treating vaginal thrush, particularly in the United Kingdom.

Method A series of semi-structured interviews was conducted with community pharmacists to investigate their views about treating women for vaginal symptoms. Community pharmacists were recruited from within Grampian primary health care NHS trust. Purposive sampling was used to identify pharmacists from different types of pharmacies (independent, small and large multiples) and locations (deprived, affluent inner city, rural), as their experience of treating vaginal symptoms was likely to be influenced by these factors. The interviews were conducted in a face-to-face setting and by telephone, using an interview schedule. Responses to open-ended questions were categorised using content analysis.

Focal points

  • Community pharmacists perceive many advantages to women for receiving anti-fungal treatment in the community pharmacy setting
  • Customer embarrassment is perceived to be the main barrier for treating women with symptoms of vaginal thrush in a community pharmacy setting
  • Further research is required to determine whether the perceptions of these participants are representative of community pharmacists in general

Results Of the 26 pharmacists contacted, 19 (73 per cent) completed interviews. Six telephone interviews were completed with five male pharmacists and one female pharmacist and 13 interviews were completed face-to-face, two of which were with male pharmacists. The results of the telephone and face-to-face interviews are not presented separately.
The average age of the pharmacists was 35 years (range 24 to 59) and their average duration of professional registration was 11 years (range 2 to 36).
The main advantages to women were perceived to be symptom relief, rapid treatment and reducing the risk of spreading the infection. The main disadvantages to the patient were cost, embarrassment and the risk of masking a serious condition.
The main advantages to the pharmacist were job satisfaction, being able to help people and increasing patient awareness regarding pharmacists' abilities in treating minor illness. The main facilitators to treating women with vaginal symptoms were a clear patient history, access to a quiet area and having a previous history of thrush. The main barriers to treatment were patient embarrassment, lack of privacy and incomplete information from the patient.
Six pharmacists thought that their personal experience of thrush had influenced their treatment of women presenting with this condition.

Discussion The pharmacists were positive towards the treatment of women with vaginal symptoms in community pharmacies. The results raised a number of issues. The belief that thrush can be spread if rapid treatment is not provided is not supported by the evidence. Access to a private area to enable confidential and sensitive questioning is an issue that cannot be resolved easily for pharmacists working in premises with no available resources. Having such a location may help to minimise the embarrassment experienced by some women who require treatment for conditions of this nature. Further research is required to determine whether the opinions expressed by the pharmacists in this study (which will be published in full in Pharmacy World and Science) are representative of community pharmacists in general. The results of this study will be used to develop a questionnaire survey that will be conducted within Grampian region, which will explore community pharmacists' views and beliefs about the treatment of women with vaginal symptoms. The items within the questionnaire will be generated using the themes and issues that were identified from the pharmacists' responses during the interviews presented here.

Department of general practice and primary care, University of Aberdeen, Westburn Road, Aberdeen AB25 2AY

References

1. Sobel JD. Candidal vulvovaginitis. Clin Obst Gynaecol 1993;36:153-65.
2. Royal Pharmaceutical Society of Great Britain. Bibliography: Prescription only medicines reclassified to pharmacy only medicines. London: The Society; 1999.