Original Research Quality supply of nonprescription medicines in Portuguese community pharmacy: An exploratory case study Paulo Veiga, M.Pharm. a, * , Luı´s V. Lapa˜o, Ph.D. b , Afonso M. Cavaco, Ph.D. a,c , Mara P. Guerreiro, Ph.D. d,e a Instituto de Investigac ¸a ˜o do Medicamento (iMed.ULisboa), Faculdade de Farma ´cia, Universidade de Lisboa, Av. Prof. Gama Pinto, 1649-003 Lisboa, Portugal b WHO Collaborating Center for Health Workforce Policy and Planning, Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Portugal c Faculdade Farma ´cia Universidade de Lisboa (FFUL), Lisbon, Portugal d Centro de investigac ¸a ˜o interdisciplinar Egas Moniz (CiiEM), Instituto Superior de Cieˆncias da Sau ´de Egas Moniz (ISCSEM), Monte da Caparica, Portugal e Escola Superior de Enfermagem de Lisboa (ESEL), Lisboa, Portugal Abstract Background: Inappropriate use of non-prescription medicines (NPM) can increase morbidity, mortality and health care associated costs. Pharmacists have a well-established role in self-medication; however, the literature shows that pharmacies performance in the supply of NPM is often suboptimal. Objective: To explore the interaction and dependability of pharmacy staff use of oral language, as well as staff’s own assessment of reasons underlying their behavior during consultation regarding NPM. Methods: In a case-study design, a high street urban community pharmacy was purposively selected as the setting. Covert patient simulation, using trained simulated patients (SPs), was used to ascertain staff’s performance in dispensing NPM, via 4 symptom-based scenarios (SbS) and 3 product-based scenarios (PbS). Performance data were converted into 2 composite indexes: the Interpersonal Performance Index (IPI) and Technical Performance Index (TPI). Audiotaped interactions were transcribed verbatim and participants’ utterances were identified, time stamped and coded employing the eight higher level categories of a framework inspired by the Roter interaction analysis system (RIAS). The transcripts of the in-depth interviews were analyzed using the Framework Approach. The tripartite model of attitudes was employed to develop the thematic framework. Results: Ten SP visits were considered for analysis. Overall, the mean TPI score was 50% and the mean IPI score was 78%. TPI was higher for SbS (63%) than PbS (31%), whilst there was little difference IPI between SbS (79%) and PbS (76%). The mean number of questions in the evaluation section of technical performance was 4 for SbS and 1 for PbS. There was a clear predominance of closed questions (32%), when compared with open questions (5.5%). Providing advice was more frequent (23.5%) than giving information (12.5%). In line with the SPs data, comparison of information-gathering in SbS and PbS shows that more questions were asked in the former (44% versus 31%), which resulted in more information given by SPs (56% and 49%, respectively). Staff’s reaction to their performance showed all the * Corresponding author. Tel.: þ351 917 153 592. E-mail address: paulojcveiga@ff.ul.pt (P. Veiga). 1551-7411/$ - see front matter Ó 2015 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.sapharm.2014.12.009 Research in Social and Administrative Pharmacy 11 (2015) 880–890