Impact of a blended learning program on pharmaceutical care during preconception, pregnancy and lactation: results from a randomized controlled trial with comparative design

Introduction: Community pharmacists acknowledge to have an important role in providing pharmaceutical care during preconception, pregnancy and lactation. However, pharmacists’ knowledge and counseling regarding this topic is still insufficient, underlining the need for educational initiatives on this topic. Hence, the ECTOPIC-study** was designed to evaluate the impact of a blended learning program (‘intervention’) on pharmacists’ barriers, knowledge, and counseling practice regarding pharmaceutical care during preconception, pregnancy and lactation. Methods: A clustered, randomized controlled trial with comparative design was performed in collaboration with a large pharmacy chain in Belgium. All pharmacists employed in 40 pharmacies that were randomly allocated to intervention and control group were eligible to participate in a blended learning program consisting of an e-learning and an on-site training day. Data were collected using online surveys, mystery shopping and pharmacy records. The three mystery cases focused on a woman's request for a pregnancy test, an over-the-counter (OTC) medicine to treat pregnancy-related nausea and an OTC product against stuffy nose during breastfeeding. Pharmacy conversations were assessed on information gathering, dispensed product, and case-specific information. A retention knowledge test was completed 3-6 months after the intervention. Results: In total, 60 pharmacists completed the post-intervention surveys (response rate: 95%). Although pharmacists reported to more frequently provide most pharmaceutical care services, they admitted that most services were not yet provided to most women. The total number of barriers decreased after the intervention, while barriers such as lack of privacy (73%) and lack of time (67%) became more prevalent. Pharmacists’ short and long-term knowledge substantially improved after the intervention, although knowledge declined again over time. During counseling, pharmacists more often provided information about folic acid and suggested the correct dose/dosage for the dispensed anti-nausea product (i.e. ginger). However, poor information gathering, dosing errors and incomplete information were still observed. Conclusions: The blended learning improved pharmacists’ barriers and short- and long-term knowledge, while counseling practice only partially improved (mainly the topic-related counseling). Hence, the blended learning as such was insufficient to enhance pharmacists’ information gathering competencies, nor to fully implement pharmaceutical care services with regard to preconception, pregnancy and lactation.