Statistical tool: e-track
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In March and February 2022, a total of 20,545 inquiries were received by email in the categories described in figure 1. Most of the inquiries concerned OTC medicines (6239, 30 %) and prescription medicines (10,602, 52 %). Other goods and skincare both made up 6 % (1,189 and 1,161 respectively) of all inquiries. On average, the mail channel received 56.3 inquiries related to these selected categories per day (see figure 1). In March and February 2022, a total of 2,941 inquiries were received on the chat in the categories described in figure 2. Most inquiries were related to the categories other goods and skincare (713, 24 %, and 636, 22 %, respectively). Eighteen percentage (516) of the inquiries concerned prescription medicine, while 13 % (389) concerned OTC medicine. On average, the chat received 9.4 inquiries per day related to these selected categories during its opening hours (see figure 2).
Observations:
In total, 42 inquiries handled by three staff members in the customer counselling department by telephone, chat and email were observed. Twenty inquiries were entered by telephone, followed by 13 emails and nine chat inquiries. The inquiries were grouped into seven topic categories: OTC, Rx, nutritional supplements, skincare, other goods, technical questions and other topics. Most inquiries were related to the category other goods (10) and technical questions (10) across all three counselling channels.
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Other than observations related to customer counselling inquiries, spontaneous observations were also recorded during the online counselling of customers. The observations were related to how staff communicated with the customers on the telephone and how staff used each other for professional sparring in counselling situations. When communicating with customers, the staff asked questions, provided feedback (both verbal and non-verbal) and used the pitch of their voices to emphasize different meanings of the conversation (e.g. a clear and defined sound when an issues was important, expressions of empathy and understanding and a harsher tone in situations where staff needed to get their message across). When staff used each other for professional sparring, it was often to confirm the counselling provided and/or to ask for help or forward the customer to a colleague.
Interviews
Six semi-structured interviews were conducted in April 2022. All interviews lasted between 30 and 45 minutes. All participants were female and had work experience at the online-only pharmacy of between one and 11 years. Three major themes were identified with related subthemes. The major themes were (1) counselling of customers at online-only pharmacies, (2) quality of counselling and (3) staff perceptions of online-only pharmacies.
Counselling of customers at an online-only pharmacy
Counselling at online-only pharmacies can be initiated both by pharmacy staff and customers. The contacts initiated by customers take place mainly through direct counselling channels – telephone, email and chat. All channels present both advantages and disadvantages. Mail correspondence may be slow if the issue presented cannot be solved in a few emails. However, staff can investigate the presented issue further and more in-depth before providing an answer, which is a clear advantage. On the other hand, the chat function is described as a great counselling tool for short, quick and simple issues. Here the staff can ask questions and promptly get an answer from the customer and then provide the correct counselling. However, the limitation of this channel is that the correspondence may become too long or complicated. The telephone is the channel that most resembles counselling at a physical pharmacy. Staff can easily ask questions and go into more depth, which is why this channel is described as advantageous for longer and more complicated counselling situations.
“The telephone, it’s more like being at the counter. Of course, you can’t see the customer, but you can still hear and feel the mood, and other things to decode.” #5, pharmacist
“On the other hand, I sometimes think: ‘This email would have been good in the chat’. Because you want to ask some counter questions.” #5, pharmacist
Pharmacy-initiated counselling includes standard emails sent when customers buy medicines or other goods from the online pharmacy website and contain basic, important, professional information. In this way, important information is provided even though the customer was never in contact with the staff at the online pharmacy. For some standard emails, the customer must reply to get the order approved, e.g. if a customer buys an excessive number of painkillers at one time.
Another type of counselling are the written materials on the website, including texts describing the products and articles on health-related topics. One interviewee describes how these materials should support the customer’s decision-making in a qualified way. A general point from several interviews was that written counselling could more easily be misinterpreted than oral counselling.
“Counselling is also what is seen on the website. This is where you search [red: for information]. For me, the counselling starts there. It starts with the customer having an issue, and then you turn to the internet and search for the issue.” #6, pharmacist
Types of inquiries and customers
The types of inquiries vary greatly, from questions about products to topics of discretion and technical issues. Counselling on specific symptoms is also seen, as well as customers wanting to know more about the excipients in the medicines or questions related to enzymes.
“Definitely also intimate questions or things people would not usually dare to ask at the [physical] pharmacy.” #4, pharmacist
Different customer types were highlighted, with emphasis on customers seeking discretion, people who cannot go to the pharmacies themselves and people who are simply tired of physical pharmacies. In addition, characteristics of customers were elderly people, younger people, families with children and people who know their medicines already.
“They buy these products because they think it is embarrassing to buy them at a [physical] pharmacy or because they are afraid that somebody comments anything loudly […].” #1, pharmacy technician
Quality of counselling
The interviewees state that online-only pharmacies and physical pharmacies are two very different settings. The Danish online-only pharmacies are subject to the same legislative requirements for advice as the physical pharmacies. Some interviewees explain how the Danish Medicines Agency performs inspections of the online-only pharmacy to ensure that the pharmacy lives up to the legislation that requires pharmacies to inform and counsel based on the need of the patient. Some interviewees also acknowledge how the online counselling is different from that at physical pharmacies and how this could affect the use of guidelines:
“We do live up to the legislation, you can say. We use some of the elements they [the Association of Danish Pharmacies] have. It is just not everything which makes a hundred percent sense [for online-only pharmacies to use].” #5, pharmacist.
Many interviewees state that counselling on the telephone resembles counselling in a physical pharmacy; thus the same quality of counselling would be expected. Written materials are also sources of quality counselling as they are created by the pharmacy staff. The same is stated by a pharmacist about the so-called standard emails; emails with basic information about specific active substances that are sent to the customers when they buy a specific product.
“Just to take part in creating these emails is extremely rewarding. And also with the article universe, I can’t say other than it gives me so much to take part in it.” #5, pharmacist.
Staff perceptions of online-only pharmacies
The interviewees describe several advantages and opportunities connected with counselling at an online-only pharmacy, but also acknowledge a number of disadvantages and difficulties. An obvious advantage is the opportunity to be more discrete than in a physical pharmacy as well as the easy accessibility for customers. This also enables staff to consult or have a dialogue with their colleagues about an issue without feeling the pressure from people in line at the counter and to investigate further before providing an answer. Most interviewees highlight that all customers get basic information when they buy medicines in the form of a standard email, which they can read if needed.
“Of course, we also have customers who would come to the pharmacy and say: ‘I do not want to have any counselling at all’, but then they get this standard email anyways. […] And then they might be home and check their email and be like: ‘Oh, I might as well read my emails’. And in this way, I feel like we might reach a target group of people who are very determined not to talk to anyone.” #4, pharmacist.
Other advantages mentioned are that online-only pharmacies can trace orders down to specific customers and have purchase restrictions.
As disadvantages and services to develop further, many interviewees mention technical aspects such as challenges related to the pricing setting, prescriptions for children, health services such as the Inhalation Technique Assessment and the New Medicine service. All interviewees highlighted the lack of non-verbal communication at online-only pharmacies – the physical signs and symptoms of the customer and weighing these up against what the customer actually buys, as well as the tone and the mood of the conversation.
“So we always try to be positive in our body language even though you can’t see our body language. Do you know what I mean?” #2, pharmacy technician
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