Communication Skills in Pharmacy Practice

By Hesham Shazly, PhD Sunday, Sept. 22nd Semester one BUE

Communication Password

welcome

YOU AS A PHARMACIST ARE MORE THAN DATA POINTS.

E - Prescriptions
Department :Pharmacy Academic :Anita Olivier

Anitas own opinion is: for pharmacy students; there will be a national electronic prescribing option in the future. The course continues to be used in the labs every Friday 3 hours in the morning and 3 hours in the afternoon. There are 5 labs in the semester and three preparations per lab. This year it was 133 students in the first semester .The potential is about 240 students for all year. Anita is hoping to expand it from optional to essential course. At the Pharmex symposium held in June 2007, the Minister of Health, told us that he is committing to establish an electronic national health database which should include electronic prescribing options.

Chapter 1

Patient-Centered Communication in Pharmacy Practice 1. 2. 3. 4. 5. 6. Overview Introduction Pharmacists responsibility Importance of communication in meeting your patients What is Patients-Centered Care? Encouraging a More Active Role in Therapeutic Drug Monitoring TDM 7. A Patient-Centered View of the Medication Use Process 8. Summary

1- Overview
Pharmacists have the potential to contribute even more to improved patient care. By reducing medication errors By improving the use of medications The key element in this process is PatientsCentered Care

2- Introduction
Why patient-centered communication is so crucial: A 36-years-old man was prescribed a Fentanyl patch to treat pain. He was not informed that heat could make the patch unsafe. He slept with a heating pad and died. The blood levels of Fentanyl was found to be 100 times more than it should be. A patient prescribed Normodyne for HTN, was dispensed Norpramin. She experienced numerous side effect, blurred vision and tremors. Minimal communication between her and the pharmacist would have prevent such error. An 83-years-old patients was given SR- diltiazem cap for HTN. Because the cap was too large to swallow the patients chewed the cap. Pulse rate shouts up. Changing to immediate release tab which easier to slow solved the issue .

2- Introduction cont.
Why patient-centered communication is so crucial: Pharmacists have increasing responsibility in avoiding such side effect and achieving the desired treatment outcome. Changing the role of pharmacist from medication-centered to Patient-Centered Care. This need to develop a trustful relationship with the patients. To involve the patient in decision making process regarding the treatment options. By helping the patients to reach the therapeutic goal. No other way to achieve this without effective communication that use Patient-Centered Care strategy.

3- Pharmacists Responsibility in Patient Care

The incidence of the adverse events and the associated cost related to mortality and morbidity are of growing concern. The Institute of Medicine (IOM) repot on patients safety due to medication errors are preventable ones. The pharmacists can play a pivotal role in reducing the medicationerrors and drug-related illness. The Patient-Centered Role envisioned by the pharmacy mission statements afford pharmacist value far beyond the drug-centered role The quality of the relationships pharmacist develop with patients depends on effective communication.

4- Importance of Communication in Meeting your Patients Care Responsibility

Communicating with your patients serves two primary function: 1. Establish relation between you and your patients 2. Exchange of information to assess your patients health conditions and evaluate the effects of treatment on the quality of life QOL Trusting relationship is essential to be real for Pharmacy Practice as all communication/activities take place on the context of this relationship. This is the base to meet professional responsibilities in patients care. The aim of the professional-patients relationship is to achieve therapeutic goals that improve patients QOL based on individual's need. Your goal is not to get patients to comply but helping to reach intended treatment outcomes. Because of your knowledge and responsibilities you must bear the greater burden of assuring effective communication.

5- What is Patients-Centered Care?

Pharmacist must be able to: 1. Perceive each patients as a person. Understand the patients illness through: social, psychological and biomedical factors. 2. Fair relationship with patients; allows to be involved in the dialogue of the treatment decision making process. 3. Build a therapeutic alliance with your patients for treatment acceptability. 4. Develop self-awareness on patients behavior

5- What is Patients-Centered Care? Cont.

Prescriptions that are practitioner-centered are focused on the decisions made by physician, patient is following rather than sharing. Dispensing a medication is a key step in the medication process. Chronic disease care consumes 75% resources. Many patients make autonomous decisions to alter the treatment regimens without consulting heath care providers. This is makes it difficult to evaluate the treatment outcome. Ultimately; patients has control over the treatment implementation. To be more productive; strength the therapeutic alliance with your patients; increase the patients participation in the treatment decision Patient perception that you care for them rather than providing the care makes a great difference.

6- Encouraging a More Active Role in TDM

Pharmacists, could enable patients and their family or caregivers to take active role in monitoring response to treatment. The information a patient provides you is essential to get treatment goals. While INR or HbA1c values provide a "scientific" basis for therapeutic monitoring; for chronic conditions you must rely on patient report of response to treatment. Treatment of depression and pain, for example, have only patient self report as the basis of evaluation of response to therapy.

6- Encouraging a More Active Role in TDM

Many other conditions such as asthma, angina, GERD, epilepsy, and arthritis rely heavily on patient report of symptoms. Certainly, patient self-monitoring of blood glucose becomes standard practice in managing diabetes Encourage the patients; to ask about the safety .If an IV is given to ask the nurse how long it takes for liquid to 'run out. Till the nurse if it doesn't seem to be dripping properly (it is too fast or too slow). Patients must be taught how to be more involved in decision making process. Their assertiveness must be encouraged and not embraced. Your role is try to establish more patient centered care.

7- 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. It may be the experience of "symptoms" or lifestyle interruption challenges or threatens the patient's sense of well-being. These include the individuals experience with the health care system; family influences; cultural differences of health, and illness info. The patient at this point may take no action to treat the condition, either because the problem is seen as minor or transitory or because the patient lacks the means to initiate treatment. Sometimes the action of self-treatment initiation through a nonmedical provider (such as a faith healer), and/or contacting a hearth care provider.

7- A Patient-Centered View of the Medication Use Process (cont.)

Pharmacist Should Encourage Patients to Share their Experience: 1. They may have unanswered questions. 2. They may have misunderstanding or misperceptions. 3. They may experience problems related to therapy and not tell you. 4. They may monitor their own response without involving you. 5. They may make their own decisions regarding the therapy. 6. They may not reveal key info to you unless you initiate a dialogue. Regardless how patients report their experience with therapy. Professional assessment is based on patient report, lab values and other physiological measures.

7- A Patient-Centered View of the Medication Use Process (cont.)

This assessment will lead to continue drug treatment, to alter treatment (i.e., to change dose, change drug, add drug), or to discontinue drug treatment. Communication aim is to make the patients understand the disease and treatment goals. The quality of the patient-professional relationship affect the decisions of both patients and you. Your communication skills are critical and can have the most effect on the outcomes of treatment. The key is to maximize patient outcomes by using patient-centered communication skills.

Review Case Study

Mr. Rowe is a patient, 65-year-old man who has osteoarthritis. For many years his hips have hurt him off and on. On days when he experienced pain he would take one dose of 400mg of ibuprofen, and that managed the pain. Gradually over the years, the pain became more frequent, and the ibuprofen did not help as much. Then his knees also began to ache when he went on walks. He talks to you as his pharmacist about how he can manage his pain without having to go to a physician because he does not want to start taking prescription drugs if he can mange with OTC medication. Question: What further information would you want to obtain from Mr. Rowe that would assist you in deciding how to be of help?

8- Summary
The patient is the focus of the medication use. Your communications skills can facilitate formation of trusting relationships. An effective communication can optimize the patients share in decision making process, consequently the appropriate use of medication and ultimately meeting the treatment goals.