Abstract
Driving-impairing medicines (DIMs) are associated with an increased risk of traffic accidents. While Dutch pharmacy staff are expected to counsel patients at the first and second dispense of DIMs, current practice suggests that second-dispense consultations are underutilized. This study explored pharmacy staff's experiences and perceived barriers in addressing driving impairment during the second dispense. Qualitative, semi-structured interviews were performed with 17 staff members in community pharmacies across the Netherlands. Transcripts were coded using thematic analysis in Atlas.ti, applying both deductive and inductive coding strategies to explore current practices and improvement needs. Participants reported that they provided detailed information on medication use, side effects, and driving impairment during the first dispense. In contrast, driving fitness was only discussed during the second dispense when patients initiated the topic, which rarely happened. Barriers to discuss DIMs included time constraints, a lack of protocols or prompts in pharmacy software, limited privacy, and patients' reluctance to communicate about this topic. Many pharmacy technicians relied on closed questioning and observed a lack of patient initiative. Facilitators included strong patient relationships, access to medical records, and a desire for training in consultation skills. Pharmacy staff expressed the need for improved protocols, better ICT (Information and Communication Technology) integration, and targeted communication tools to support safe use of DIMs. In conclusion, second-dispense consultations for DIMs are underused and can support patients in safer medication use. Improved implementation will lead to better-informed choices about medicines and driving, and strengthen the pharmacy's contribution to traffic safety.