RESEARCH ARTICLE Management of common ailments requiring referral in the pharmacy: a mystery shopping intervention study Jack Charles Collins 1 • Carl Richard Schneider 1 • Renee Faraj 1 • Frances Wilson 1 • Abilio Cesar de Almeida Neto 1 • Rebekah Jane Moles 1 Received: 23 March 2017 / Accepted: 26 June 2017 / Published online: 6 July 2017 Ó Springer International Publishing AG 2017 Abstract Background Pharmacists can play a key role in managing ailments through their primary roles of supply- ing over-the-counter (non-prescription) medicines and advice-giving. It must be ensured that pharmacy staff practise in an evidence-based, guideline-compliant manner. To achieve this, mystery shopping can be used as an intervention to assess and train pharmacy staff. Objective To determine if repeated student pharmacist mystery shopping with immediate feedback affected the outcome of scenarios requiring referral to a medical practitioner. To determine what, if any, factors may influence whether referral occurred. Setting Thirteen community pharmacies across metropolitan Sydney, Australia. Methods Sixty-one student pharmacist mystery shoppers visited 13 community pharmacies across metropolitan Sydney once weekly over nine weeks between March–October 2015 to conduct audio-recorded mystery shopping visits with assigned scenarios (asthma, dyspepsia, diarrhoea). Students returned to the pharmacy immediately to provide staff members with feedback. Pharmacy staff were scored by mystery shoppers according to a standardised scoresheet. Score data and other characteristics, such as the assigned scenario, were analysed via correlation and logistic regression modelling. Main outcome measure Whether a student mystery shopper was appropriately referred to a medical practitioner based on the presenting symptoms. Results 158 visits were eligible for analysis. Referral to a medical practitioner was appropriately made in 66% of visits. The regression model provided an R2 value of 0.73; the ques- tioning score of the interaction and if a pharmacist was involved in the interaction were significant predictor of appropriate outcome (p \0.001 and p \0.01 respectively). Statistically significant differences were found between median questioning and total scores of interactions involving a pharmacist compared to those that did not (p \ 0.001). No statistically significant correlation was found between the number of visits and appropriate outcome (p [ 0.05). Conclusions Mystery shopping with feedback did not improve pharmacy staff performance over time. Increased questioning and involvement of a pharmacist in the interaction were significant predictors of referral to a medical practitioner occurring. Keywords Australia Á Community pharmacy Á Mystery shopping Á OTC drugs Á Pseudo patient Á Referral Á Simulated patient Impacts on practice • When presented with a request for a non-prescription medicine, community pharmacy staff in Sydney were successfully able to identify ‘‘red-flag’’ symptoms and refer the pseudo-patient to a medical practitioner in 66% of cases. • When a pharmacist was involved in the interaction with the pseudo patient requesting a non-prescription med- icine (and not just a pharmacy support staff member), referral to a medical practitioner was more likely to occur than when a pharmacist was not involved. • Repeated mystery shopping visits with coaching and feedback did not improve referral rates over time. Electronic supplementary material The online version of this article (doi:10.1007/s11096-017-0505-8) contains supplementary material, which is available to authorized users. & Jack Charles Collins jack.c.collins@sydney.edu.au 1 The University of Sydney, Sydney, NSW, Australia 123 Int J Clin Pharm (2017) 39:697–703 DOI 10.1007/s11096-017-0505-8