Background In 2014, New Zealand reclassified sildenafil (for erectile dysfunction) to allow supply by specially trained pharmacists under strict criteria. Objective The study aimed to determine pharmacists’ experiences and perspectives on the training for, and supply of sildenafil under this model. Setting New Zealand community pharmacy. Method This qualitative study captured data with a semi-structured interview used with purposively-sampled participants. A maximum variation sample was used to select a wide range of pharmacists working in various pharmacies, including pharmacists who were trained to provide sildenafil and those not trained to supply sildenafil. Consenting pharmacists were interviewed, with interviews audio-recorded and transcribed. Analysis used a framework approach. Main outcome measures Topics explored included: satisfaction and experience of the training; suitability and usability of the screening tools; experiences of the supply process and why some pharmacists chose not to become trained. Results Thirty-five pharmacists were interviewed. Training was seen as uncomplicated and the screening tools provided confidence that key consultation areas were covered. Most consultations reportedly took 15–20 min, some up to 60 min. Pharmacists reported being comfortable with the consultations. Many men requesting supply fell outside of the parameters, resulting in medical referral. This new model of supply was seen as a positive for pharmacists and their patients. Unaccredited pharmacists reported a perceived lack of interest from men, or ability to provide the service as reasons for not seeking accreditation. Conclusion New Zealand’s model of pharmacist supply of sildenafil appears workable with some areas for improvement identified.
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Gauld NJ, Kelly FS, Kurosawa N, Bryant LJM, Emmerton LM, Buetow SA. Widening consumer access to medicines through switching medicines to non-prescription: a six country comparison. PLoS ONE. 2014;9(9):e107726.
Brass EP. Changing the status of drugs from prescription to over-the-counter availability. N Engl J Med. 2001;345(11):810–6.
Bradley C, Blenkinsopp A. Over the counter drugs: the future for self medication. BMJ. 1996;312(7034):835–7.
Gauld N. Why the resurgence of OTC reclassifications in the UK is a good thing. Clin Pharm. 2017. https://doi.org/10.1211/cp.2017.20202645.
Ahmed S, Rutter PM. UK community pharmacists experiences on over-the-counter tamsulosin. SelfCare. 2011;2(6):152–9.
Mann S. Simvastatin for self-medication in the UK. SelfCare J. 2010;1(1):29–43.
Wilkes D. Merck & Co deal boosts Bayer but Oxytrol goes. OTC Toolbox 2015.
Paudyal V, Hansford D, Cunningham S, Stewart D. Over-the-counter prescribing and pharmacists’ adoption of new medicines: diffusion of innovations. Res Social Adm Pharm. 2013;9(3):251–62.
Editorial. Over-the-counter triptans–making the switch. Lancet Neurol. 2005;4(10):587.
NIH Consensus Conference. Impotence. J Am Med Assoc. 1993;270(1):83–90.
Rubin N, Wylie K. Should sildenafil be available over the counter? Br Med Bull. 2009;90:53–62.
Tsertsvadze A, Yazdi F, Fink HA, MacDonald R, Wilt TJ, Soares-Weiser K, et al. Diagnosis and treatment of erectile dysfunction. Ottawa: University of Ottawa Evidence-based Practice Center; 2009.
Paige NM, Hays RD, Litwin MS, Rajfer J, Shapiro MF. Improvement in emotional well-being and relationships of users of sildenafil. J Urol. 2001;166(5):1774–8.
Lewis RW, Fugl-Meyer KS, Corona G, Hayes RD, Laumann EO, Moreira ED Jr, et al. Definitions/epidemiology/risk factors for sexual dysfunction. J Sex Med. 2010;7(4 Pt 2):1598–607.
Levine GN, Steinke EE, Bakaeen FG, Bozkurt B, Cheitlin MD. Sexual activity and cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2012;125:1058–72.
Shamloul R, Ghanem H. Erectile dysfunction. Lancet. 2013;381(9861):153–65.
Jannini EA, Sternbach N, Limoncin E, Ciocca G, Gravina GL, Tripodi F, et al. Health-related characteristics and unmet needs of men with erectile dysfunction: a survey in five European Countries. J Sex Med. 2014;11(1):40–50.
Morales AM, Ibanez J, Machuca M, Pol-Yanguas E, Schnetzler G, Renedo VP. The EPIFARM study: an observational study in 574 community pharmacies in Spain characterizing patient profiles of men asking for erectile dysfunction medication. J Sex Med. 2010;7(9):3153–60.
Shaeer O. The Global Online Sexuality Survey (GOSS): the United States of America in 2011 chapter II: phosphodiesterase inhibitors utilization among English speakers. J Sex Med. 2013;10(2):532–40.
Jackson G, Arver S, Banks I, Stecher VJ. Counterfeit phosphodiesterase type 5 inhibitors pose significant safety risks. Int J Clin Pract. 2010;64(4):497–504.
Nicolosi A, Buvat J, Glasser DB, Hartmann U, Laumann E, Gingell C. Sexual behavior, sexual dysfunction and related help seeking patterns in middle-aged and elderly Europeans: the global study of sexual attitudes and behaviors. World J Urol. 2006;24:423–8.
Chew KK, Stuckey B, Bremner A, Earle C, Jamrozik K. Male erectile dysfunction: its prevalence in Western Australia and associated sociodemographic factors. J Sex Med. 2008;5(1):60–9.
Colson MH, Roussey G. Screening and managing erectile dysfunction in diabetic patients (review). Sexologies. 2013;22(1):e1–8.
Classification of Medicines. New Zealand Gazette. 2014;2014-go6426(127):3556.
Protocol for the sale and supply of pharmacist only medicines for chronic conditions. Pharmacy Council of New Zealand. http://www.pharmacycouncil.org.nz/cms_show_download.php?id=212. Accessed 11 May 2016.
International Pharmaceutical Federation (FIP). An overview of current pharmacy impact on immunisation a global report 2016. The Hague: International Pharmaceutical Federation; 2016.
Yang YT, Kozhimannil KB, Snowdon JM. Pharmacist-prescribed birth control in Oregon and other states. JAMA. 2016;315:1567–8.
Nissen L, Glass B, Lau E, Rosenthal M. Queensland pharmacist immunisation pilot phase 1 pharmacist vaccination—influenza final report 2015. https://eprints.qut.edu.au/91903/.
Gardner JS, Miller L, Downing DF, Le S, Blough DK, Shotorbani S. Pharmacist prescribing of hormonal contraceptives: results of the direct access study. J Am Pharm Assoc. 2008;48:212–26.
Parsons J, Adams C, Aziz N, Holmes J, Jawad R, Whittlesea C. Evaluation of a community pharmacy delivered oral contraception service. J Fam Plan Reprod Health Care. 2013;39(2):97–101.
Braund R, Henderson E, McNab E, Sarten R, Wallace E, Gauld N. Pharmacist-only trimethoprim: pharmacist satisfaction on their training and the impact on their practice. Int J Clin Pharm. 2016;38(6):1357–61.
Gauld NJ, Zeng ISL, Ikram RB, Thomas MG, Buetow SA. Antibiotic treatment of women with uncomplicated cystitis before and after allowing pharmacist-supply of trimethoprim. Int J Clin Pharm. 2017;39(1):165–72.
Paudyal V, Hansford D, Cunningham S, Stewart D. Community pharmacists’ adoption of medicines reclassified from prescription-only status: a systematic review of factors associated with decision making. Pharmacoepidemiol Drug Saf. 2012;21(4):396–406.
Paudyal V, Hansford D, Cunningham S, Stewart D. Pharmacists’ perceived integration into practice of over-the-counter simvastatin five years post reclassification. Int J Clin Pharm. 2012;34(5):733–8.
Patton MQ. Qualitative research and evaluation methods. 3rd ed. London: Sage Publications; 2002.
Pope C, Ziebland S, Mays N. Qualitative research in health care. Analysing qualitative data. BMJ. 2000;320(7227):114–6.
Gauld N, Kelly F, Shaw J. Is non-prescription oseltamivir availability under strict criteria workable? A qualitative study in New Zealand. J Antimicrob Chemother. 2011;66(1):201–4.
Gauld NJ, Jennings LC, Frampton C, Huang QS. Five years of non-prescription oseltamivir: effects on resistance, immunization and stock-piling. J Antimicrob Chemother. 2012;67:2949–56.
Hattingh HL, Sim TF, Parsons R, Czarniak P, Vickery A, Ayadurai S. Evaluation of the first pharmacist-administered vaccinations in Western Australia: a mixed-methods study. BMJ Open. 2016. https://doi.org/10.1136/bmjopen-2016-011948.
Dunn S, Brown TER, Alldred J. Availability of emergency contraception after its deregulation from prescription-only status: a survey of Ontario pharmacies. CMAJ. 2008;178(4):423–4.
Symonds T, Dean JD, Carr A, Carlsson M, Marfatia A, Schnetzler G. A feasibility study comparing pharmacist and physician recommendations for sildenafil treatment. J Sex Med. 2011;8(5):1463–71.
Schneider CR, Gudka S, Fleischer L, Clifford RM. The use of a written assessment checklist for the provision of emergency contraception via community pharmacies: a simulated patient study. Pharm Pract. 2013;11(3):127–31.
Edwards N, Gorman Corsten E, Kiberd M, Bowles S, Isenor J, Slayter K, et al. Pharmacists as immunizers: a survey of community pharmacists’ willingness to administer adult immunizations. Int J Clin Pharm. 2015;37(2):292–5.
Kirby M, Phillips G, Carr A. Professional competence of pharmacists in recommending Flomax Relief MR (tamsulosin) to men with lower urinary tract symptoms. Pharm J Online. 2011:1–5.
Conflicts of interest
NG works on widening access to medicines through reclassification, and has consulted to industry on reclassification of erectile dysfunction medicines, including receiving consulting fees from Douglas Pharmaceuticals for the reclassification of sildenafil in New Zealand. The rest of the authors have nothing to declare.
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Braund, R., Ratnayake, K., Tong, K. et al. Pharmacist supply of sildenafil: pharmacists’ experiences and perceptions on training and tools for supply. Int J Clin Pharm 40, 650–658 (2018). https://doi.org/10.1007/s11096-018-0622-z
- Community pharmacy services
- Erectile dysfunction
- New Zealand
- Pharmacist’s training