Patient-Centered Communication in Pharmacy Practice

week 1 Fall 2014-2015

Hiwa K Saaed PhDCollege of PharmacyUniversity of SulaimaniHiwa.saaed@univsul.edu.iq, hiwa.saaed@belmont.edu

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LEARNING OBJECTIVES

• Overview• Introduction• Pharmacists’ Responsibility in Patient Care• Importance of Communication in Meeting Your Patient

Care Responsibilities• What is Patient-Centered Care?• Encouraging a More Active Patient Role in Therapeutic

Monitoring• A Patient-Centered View of the Medication Use Process• Summary

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OVERVIEW

• In order to meet their professional responsibilities, pharmacists have become more patient-centered in their provision of pharmaceutical care.

• Pharmacists have the potential to contribute even more to improved patient care through efforts – to reduce medication errors – and improve the use of medications by patients.

• Using effective communication skills is essential in the provision of patient care.

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INTRODUCTION

WHY IS PATIENT-CENTERED COMMUNICATION SO CRUCIAL TO A PROFESSIONAL PRACTICE?Consider the following:• A 36-year-old man was prescribed a fentanyl patch to treat

pain resulting from a back injury. He was not informed that heat could make the patch unsafe to use. He fell asleep with a heating pad and died. The level of fentanyl in his bloodstream was found to be 100 times the level it should have been (Fallik, 2006).

• A patient prescribed Normodyne (labetalol) for hypertension (HTN) was dispensed Norpramin (desipramine). She experienced numerous side effects, including blurred vision and hand tremors. (ISMP, 2004).

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PHARMACISTS RESPONSIBILITY IN PATIENT CAREPATIENT-CENTERED CARE (PCC)

• Switch from a “medication-centered” or “task-centered” practice to patient-centered care.

• It is not enough to simply provide medication, • Pharmacists are accepting increased responsibility in

assuring that patients”– avoid adverse effects of medications – and reach desired outcomes from their therapies.

• Pharmacists must participate in activities that enhance patient adherence and the wise use of medication.

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PHARMACISTS RESPONSIBILITY IN PATIENT CAREPATIENT-CENTERED CARE (PCC)

PCC depends on your ability TO• Develop trusting relationships with patients, • Engage in an open exchange of information, • Involve patients in the decision-making process regarding

treatment, • Help patients reach therapeutic goals that are understood and

endorsed by patients as well as by health care providers.

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PHARMACISTS RESPONSIBILITY IN PATIENT CAREPATIENT-CENTERED CARE (PCC)

• The incidence of preventable adverse drug events and the cost to society associated with medication-related morbidity and mortality are of growing concern.

• The potential of pharmacists to play a pivotal role in reducing the incidence of both medication-related errors and drug-related illness is also receiving increased attention.

PHARMACEUTICAL CARE: Hepler and Strand (1990) have made a compelling case for the societal need for pharmaceutical care, which they define as “ the responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patent’s quality of life”.Using effective communication skills is essential in the provision of patient care.

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Importance of Communication in Meeting Your Patient Care Responsibilities

Advantage of PCCThe communication process between health professionals and patients serves two primary functions:

1. It establishes an ongoing therapeutic relationship between the professional and the patient.

2. It provides the exchange of information necessary to: – assess a patient’s health condition, – implement treatment of medical problems, – and evaluate the effects of treatment on a patient’s quality

of life.

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Importance of Communication in Meeting Your Patient Care Responsibilities

• The ultimate purpose of the relationship is to achieve mutually understood and agreed upon goals for therapy that improve your patients’ quality of life (patient outcomes ).

• Your goal, for example, is changed from providing patients with drug information to a goal of assuring that patients understand their treatment in order to take medications safely and appropriately.

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WHAT IS PATIENT CENTERED CARE (PCC)?

the five dimensions of PCC (Mead and Bower (2000) The pharmacist must be able to:1. Understand the illness experience of the

patient: the social, psychological, and biomedical factors

2. Perceive each patient's experience as unique.3. Foster a more equal relationship with

patients.4. Build a therapeutic alliance with patients to

meet mutually understood goals of therapy.5. Develop self-awareness of personal effects

on patients.Apr 10, 2023

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ENCOURAGE PATIENT ROLE IN THERAPEUTIC MONITORING

• While INR or HbA1c values may provide a scientific basis for therapeutic monitoring. – Patient management of warfarin dosing have led to

reduced incidence of major bleeding. – Certainly, patient self-monitoring of blood glucose has

become standard practice in managing diabetes.

• For many chronic conditions you must rely on patient report of response to Rx. Depression, pain, asthma, angina, epilepsy and arthritis rely heavily on patient report of symptoms.

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ENCOURAGING A MORE ACTIVE PATIENT ROLE IN THERAPEUTIC MONITORING

The healthcare professional should encourage patients to share experiences with therapy because THEY• have unanswered questions• have misunderstandings• experience problems to therapy• can “monitor” their own responses to treatment• make their own decisions regarding therapy• may not reveal information to you unless you initiate a

dialogue

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A PATIENT-CENTERED VIEW OF THE MEDICATION USE PROCESS

• A patient-centered view of the medication use process focuses on the patient role in the process.

Step 1: patient perception and interpretation• The medication use process for patients begins when

the patient perceives a health care need or health-related problem.

• The patient then interprets the perceived problem. This interpretation is influenced by a host of psychological and social factors unique to the individual.

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STEP 1: PATIENT PERCEPTION AND INTERPRETATION

• These include – the individual’s previous experience with the formal health care

system; – family influences;– cultural differences in the conceptualization of “health” and “illness”; – knowledge of the problem (individuals vary greatly in levels of medical

and biological knowledge); – health beliefs that may or may not coincide with accepted medical

“truths”; – psychological characteristics; – personal values, motives, and goals; and so on. – outside forces, such as family members who offer their own

interpretations and advice.

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STEP2: PATIENT ACTION

• No action: either because – the problem is seen as minor or transitory – or because the patient lacks the means to initiate

treatment. • Takes action: the patient action can include:– initiation of self-treatment, – initiation of contact with a nonmedical provider

(such as a faith healer), – and/or contact with a health care provider.

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STEP3: PATIENT COMMUNICATION

• Patient must describe his “symptom” experience and to some extent his interpretation of that experience to physician, pharmacist, or other health care practitioner.

• Diagnosis: Once the health care providers reach a professional assessment or diagnosis of the patient’s problem based on patient report, examination, and other data,

• They make a recommendation to the patient. • If the recommendation is to initiate medication

treatment, patients may or may not carry out the recommendation.

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PATIENTS MAY NOT CARRY OUT THE RECOMMENDATION.

• Data indicate that large numbers of prescriptions are written that are never filled.

• Approximately 20% of people report that they take less prescription medication than recommended because of cost.

• Failure to initiate prescribed therapy may be caused by– economic constraints,– a lack of understanding of the purpose of the recommendation, – or failure to “buy into” the treatment plan. – Some of these patient decisions may, in fact, reflect a failure in

the communication process between the patient and the health care provider.

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PATIENTS MAY CARRY OUT THE RECOMMENDATION.

• When patients do accept the recommendations to initiate drug treatment, obtain the medication, and attempt to follow the regimen as prescribed, they can do so only to the best of their ability as they understand the drugs are intended to be taken.

• For many patients, medication taking includes misuse caused by:– misunderstanding of what is recommended – or by unintended deviations from the prescribed treatment

regimen (e.g., doses are forgotten). – intentional modifications of the regimen.

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SUMMARY• The patient is the focus of the medication use

process. Your communication skills can– facilitate formation of trusting relationships with patients. – fosters an open exchange of information and a sense of

“partnership” between you and your patients.

• An effective communication process can– optimize the chance that patients will make informed

decisions, – use medications appropriately, – and, ultimately, meet therapeutic goals.

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HOMEWORKREVIEW QUESTIONS

1. What is patient-centered care?2. What are the two primary functions that the

communication process serves between health professionals and patients?

3. What is the benefit of analyzing the medication use process from the point of view of patients?