Counselling customers at risk of the triple whammy effect at community pharmacies – A feasibility study

• Published in: Exploratory Research in Clinical and Social Pharmacy
• Main Authors: Rikke Nørgaard Hansen, Alaa Burghle, Sofie Brøndal Grünfeld, Anne Mette Jørgensen, Stine Westergaard, Hanar Hamid, Charlotte Verner Rossing
• Format: Article in Journal/Newspaper
• Language: English
• Published: Elsevier 2023
• Subjects: Community pharmacy; Triple whammy; Medication safety; Patient safety; Counselling; Patient information; Pharmacy and materia medica; RS1-441; Faroe Islands
• Online Access: https://doi.org/10.1016/j.rcsop.2023.100339; https://doaj.org/article/e74689163eb74975aa289b6cacaf00cd

The combination of diuretics, angiotensin-converting enzyme inhibitors (ACE-i)/angiotensin II receptor blockers (ARBs) and non-steroidal anti-inflammatory drugs (NSAID) involves a risk of acute renal failure known as the triple whammy effect (TWE). NSAID can be provided by prescription or over the counter (OTC) and community pharmacies counsel on this medication every day to contribute to medication safety. The objective of this study is to test the feasibility of an intervention where community pharmacies identify and counsel customers at risk of the TWE.Participating pharmacies were recruited across Denmark and the Faroe Islands. In April to May 2021, all staff at 13 community pharmacies chose 10 workdays to collect data in an electronic tool on their risk assessment, the customers' medication, and counselling about the TWE for customers asking for NSAID. Pharmacy staff were instructed in correct data collection and received learning material and a patient information leaflet on the TWE. These data were analysed descriptively. Staff evaluated the learning material and patient information leaflet in a questionnaire. The quantitative answers from the questionnaire were analysed descriptively and the qualitative answers were analysed using content analysis.According to the pharmacies' risk assessment, 12.1% (n = 215) of customers asking for NSAID were at risk of the TWE. The data on customers' medication showed that only 8.0% (n = 142) were actually at risk of TWE. Of those, 43.0% (n = 61) asked for NSAID on prescription and 57.0% (n = 81) for OTC. In the evaluation of materials pharmacy staff reported overall satisfaction with the learning material, which they reported increased their knowledge of TWE and helped them in their counselling. They also reported satisfaction with the patient information leaflet.Despite pharmacy staff reporting satisfaction with the learning material, it still did not educate staff well enough in assessing the risk of TWE for customers asking for NSAID. More research is needed on TWE ...