Shaping practice behaviour: novel training methodology

Context Some studies that have used “pseudo-patron” methods have provided the basis for criticism of pharmacists' performance and have stigmatised these methods in pharmacy research. Objective To test and refine the use of pseudo-patron methodology, with feedback to practitioners, as a means of implementing behaviour change. Method In the studies reported in this paper practice behaviour was shaped by conducting a workshop and then providing ongoing training in the form of feedback and coaching immediately after a pseudo-patron visit. The involvement of pseudo-patrons was negotiated with pharmacists and their staff and embedded within their professional development. Results An initial study showed that, compared with controls, pseudo-patron trained pharmacists were significantly more likely to identify off-label (not in accordance with label specifications) analgesic use (P<0.01) and were more likely to discuss the use of alternatives (P<0.02). The methodology was refined and in a subsequent study pharmacists were even more likely to identify misuse (P<0.001), assess readiness to change (P<0.001) and deliver an appropriate intervention (P<0.001). Conclusions The results of the studies presented in this paper demonstrate that the inclusion of pseudo-patron visits in pharmacist training is feasible and that a combination of workshops and performance feedback, including positive and corrective elements, can produce substantial protocol adherence in the natural setting. The use of pseudo-patron methods as part of a training programme is effective in shaping behaviour of pharmacists and pharmacy assistants.