The All-Russian Union of Patients found out what is offered to customers in pharmacies

The All-Russian Union of Patients (VSP) sent “mystery shoppers” to Russian pharmacies – and got depressing results. It turned out that 17.8% of pharmacists do not ask any clarifying questions for the selection of an over-the-counter drug, 30.3% do not find out the symptoms and characteristics of well-being, and 69.7% are not interested in customer preferences. But the main thing is that pharmacists often offer an “analogue” to the requested medicine, which is actually a dietary supplement (BAA). GSP proposed to the State Duma influence the work of pharmacies, in particular, regulate the circulation of dietary supplements.

The All-Russian Union of Patients assessed how pharmacy chains work with the most common types of patient requests. To do this, VSP experts from March 31 to April 15, 2023 studied the work of 270 pharmacies in 15 largest regions of Russia. In each city included in the sample, “mystery shoppers” visited 18 pharmacies from four federal chains (“April”, “Planet Health”, “Doctor Stoletov / Ozerki”, “Rigla / Be healthy”). For comparison, the sample included pharmacies not belonging to these chains, from two to five in each city.

According to the GSP, Russia ranks third among developed countries in terms of the number of pharmacies (65,000, or 4.47 per 10,000 people). The European average is 3.1; in the world – 2.5. At the same time, the share of independent brick-and-mortar pharmacies in Russia has dropped sharply to 18% in recent years. The market is rapidly monopolizing, the union pays attention: since 2014, the share of pharmacy chains in the top 3 has tripled in terms of the number of outlets and 3.5 times in terms of turnover. The chains in the top 10 own 54% of the turnover.

About 30% of patients, instead of visiting a doctor, immediately go to a pharmacy, according to the union, and 61%, when choosing drugs, are guided by the advice of a pharmacist.

At the same time, as the study showed, 17.8% of pharmacists do not ask any clarifying questions for the selection of the drug, 30.3% do not find out the symptoms and features of well-being, 69.7% are not interested in drug preferences during the consultation. Most often, pharmacy staff recommended the drug without specifying the specifics of the patient’s condition in case of complaints of diarrhea (31.1% of all pharmacies visited by “mystery visitors”). Less often, the situation with the recommendation of the drug without taking into account the needs was encountered in the selection of drugs for hemorrhoids (13%). This was much less common with complaints of cough (7.3%). If the pharmacy worker did not identify the characteristics of the patient’s condition, only 34.4% of the recommended drugs corresponded to the patient’s state of health.

An important result of the test: even if the drug needed by the patient was available in the pharmacy, 47% of pharmacists proactively proposed another option. The recommended drugs were equivalent to the requested drug in terms of active substance and dosage only in 23.3% of cases. But in 62% of cases, the recommendations contained dietary supplements, and in 15% of cases these were dietary supplements that were not included by medical experts in the list of necessary drugs for this condition.

“Today, pharmacists do not perform the function of independent counseling and primary care, but an advertising agent. The bonus system is integrated into sales and staff incentives,” the study says.

Yan Vlasov, co-chairman of the All-Russian Union of Patients, chairman of the Council of Public Organizations for the Protection of Patients’ Rights under Roszdravnadzor, member of the Human Rights Council under the President of Russia, considers it necessary to influence the work of pharmacy chains. In particular, to limit marketing bonuses, which are a significant part of pharmacies’ income, and to control the mark-up on subsidized and budget drugs. In his opinion, it is important to ensure the influx of new personnel into the pharmaceutical industry and create a unified regulatory system – today, almost every region regulates the activities of pharmacies in its own way. “Special attention is required to regulate the circulation of dietary supplements. There is also a need to create a federal agency for the management of pharmacy chains. All these proposals will be submitted to the State Duma for consideration by the United Russia faction,” Mr. Vlasov said.

The Pharmaceutical Guild and the Russian Association of Pharmacy Chains did not respond to Kommersant’s request. The Union of Professional Pharmaceutical Organizations noted that “the study does not inspire confidence.”

The press service of Roszdravnadzor explained that advising and informing customers is one of the key functions of a pharmacy organization. The requirements for the scope of such participation of the pharmacist depend “on the type of goods sold.” Thus, pharmaceutical counseling is carried out, including when the patient has not consulted a doctor and asks for help from a pharmacy worker. In such cases, we are talking only about over-the-counter drugs, Roszdravnadzor emphasized. “People who feel unwell often turn to a pharmacist. During a pharmaceutical consultation, he should first of all give accessible recommendations. In some cases, recommend to see a doctor,” the press service said, urging citizens “not to self-medicate.”

Alexander Gorshkov, deputy director for scientific and outpatient work at the National Research Center for Therapy and Preventive Medicine of the Russian Ministry of Health, believes that the practice of “prescribing” drugs by pharmacists without a doctor’s appointment should be minimized.

“A pharmacist can advise citizens on commercially available drugs, including the availability of other trade names and prices for them, on the procedure for using or using pharmacy products, including methods of administration, dosing regimens, therapeutic effects, contraindications. He can assist in the selection of over-the-counter drugs,” Mr. Gorshkov said. “However, the choice of therapy, taking into account the possible individual characteristics of the patient, should be carried out by the attending physician.”

Natalia Kostarnova