Pharmacy students’ self-reported attitudes, beliefs and behaviours about communicating with patients, measured over time

Background: Pharmacy students receive training to effectively communicate with patients about their medications.Objectives: A theory-based approach (Communication Accommodation Theory [CAT]) was used to investigate the impact of communication skills' tutorials on Pharmacy students' self-reported attitudes, beliefs and behaviours in patient communication.Methods: Final year Pharmacy students completed an online, 30-item, patient-centred communication survey at three points in time, before and after attending three CAT-based tutorials (Survey #1 and Survey #2). Survey #3 was distributed six to twelve months into students' intern training year (post-graduation). Differences between participants' responses over time were measured and analysed.Results: Response rates were 78% for Survey #1, 84% for Survey #2, and 28% for Survey #3. Further analysis indicated that Survey #3 respondents were not statistically different from the larger sample size. Key areas changed from baseline (Survey #1) to post tutorials (Survey #2) and were sustained well into Pharmacy students' intern year (Survey #3).Conclusions: This novel research indicated growing awareness and retention of key communication behaviours over time

Hospital pharmacists' perceptions of medication counseling: a focus group study

Background Medication counseling sessions are key times for a pharmacist to speak to patients about their medications and the changes made to their therapies during their hospital stay. Objectives To explore hospital pharmacists' perceptions of their roles and goals in patient medication counseling, and perceived barriers and facilitators to achieving their goals. Methods Hospital pharmacist focus groups were held in two tertiary referral hospitals. Eligible pharmacists had provided medication counseling within the previous six months in inpatient and/or outpatient settings. Interested pharmacists attended a focus group designed to elicit their opinions and perceptions of patient medication counseling. Focus groups were audio recorded and transcribed verbatim. Inductive thematic analysis was applied to the data to identify initial patterns (codes) which were then organized into common overarching themes using NVivo software. The codes were reviewed for reliability by pharmacists independent of the focus groups. Results Six, 1-h focus groups were conducted with a total of 24 pharmacists participating. Saturation of information was determined after four focus groups. Greater than 80% consensus was achieved for reliability of the identified codes. A number of themes emerged from these codes around the goals, roles, and the barriers and facilitators to meeting these goals. Pharmacists' patient-centered goals in medication counseling were to build rapport, to empower patients and to improve patients' experience, health and safety. These goals would be accomplished through specific roles such as being an assessor, educator and problem-solver. Pharmacists frequently cited time pressures caused by systemic (hospital), and pharmacy specific processes as key challenges to achieving their goals. Factors that enabled pharmacists to meet their goals were those related to effective interprofessional collaboration and the quality of professional practice (such as training, expanded roles and advanced planning for discharge). Conclusions Hospital pharmacists emphasized patient-centered goals in medication counseling and outlined the challenges to meet those goals. The findings from this study will be used to develop strategies for effective communication and inform pharmacy practice changes to improve patient care

Hospital pharmacists’ and patients’ views about what constitutes effective communication between pharmacists and patients

The study's objective was to explore hospital pharmacists' and patients' views about what constitutes effective communication exchanges between pharmacists and patients.This was a novel theory-based qualitative study using semi-structured interviews to elicit patients' and pharmacists' perspectives. Pharmacists providing clinical pharmacy services in either inpatient or outpatient settings were recruited first. Eligible patients had been admitted to a study pharmacist's practice area and were prescribed three or more medications to manage a chronic disease(s). Following each pharmacist-patient medication counselling session, semi-structured interviews were held separately with patients and pharmacists. Participants were asked questions intended to explore their views about what constitutes an effective pharmacist-patient conversation. Audio recordings were transcribed verbatim, analysed using a process of inductive thematic analysis and then mapped to Communication Accommodation Theory strategies. Observational notes and reflexive note taking were conducted throughout.Twelve pharmacists each engaged four individual patients for a total of 48 pharmacist-patient conversations (resulting in 48 separate interviews with pharmacists and patients). An overall shared goal was the assurance of patients' confidence in managing their medications at home. Themes included shared colloquialisms/slang, well-explained information, engagement, established rapport and empowerment. Participants provided rich exemplars for each of the themes.Pharmacists and patients provided valuable insights about what makes pharmacist-patient interactions effective. Patient-identified preferences for pharmacist-patient exchanges may help guide pharmacy students and practitioners to engage patients in effective conversations

Investigating strategies used by hospital pharmacists to effectively communicate with patients during medication counselling

Background: Medication counselling opportunities are key times for pharmacists and patients to discuss medications and patients’ concerns about their therapy. Communication Accommodation Theory (CAT) describes behavioural, motivational and emotional processes underlying communication exchanges. Five CAT strategies (approximation, interpretability, discourse management, emotional expression and interpersonal control) permit identification of effective communication. Objective: To invoke CAT to investigate communication strategies used by hospital pharmacists during patient medication counselling. Design: This was a theory-based, qualitative study using transcribed audiorecordings of patients and hospital pharmacists engaged in medication counselling. Setting and participants: Recruited pharmacists practised in inpatient or outpatient settings. Eligible patients within participating pharmacists’ practice sites were prescribed at least three medications to manage chronic disease(s). Main outcome measures: The extent to which pharmacists accommodate, or not, to patients’ conversational needs based on accommodative behaviour described within CAT strategies. Results: Twelve pharmacists engaged four patients (48 total interactions). Exemplars provided robust examples of pharmacists effectively accommodating or meeting patients’ conversational needs. Non-accommodation mainly occurred when pharmacists spoke too quickly, used terms not understood by patients and did not include patients in the agenda-setting phase. Multiple strategy use resulted in communication patterns such as “information-reassurance-rationale” sandwiches. Discussion and conclusions: Most pharmacists effectively employed all five CAT strategies to engage patients in discussions. Pharmacists’ communication could be improved at the initial agenda-setting phase by asking open-ended questions to invite patients’ input and allow patients to identify any medication-related concerns or issues

Assessing communication behaviours of hospital pharmacists: how well do the perspectives of pharmacists, patients, and an independent observer align?

Pharmacists need effective communication skills to provide high-quality patient care. To date, little has been published about hospital pharmacists’ communication behaviours, most is atheoretical, and has not studied patients and pharmacists as a dyad. We investigated how well pharmacists’ and patients’ perspectives of their shared conversation aligned, and how closely these perspectives matched that of an outsider (observer). We invoked communication accommodation theory using audio-recorded, semi-structured interviews, held separately with hospital patients (n = 48) and pharmacists (n = 12). Quantitative analyses indicated where patients, pharmacists, and observer perspectives aligned and occasions where they did not. With some exceptions, most pharmacists and patients held similar opinions about pharmacist communication behaviours. Observer–pharmacist discrepancies highlighted areas for further communication development using communication accommodation theory as a training tool

Developing Preliminary Steps in a Pharmacist Communication – Patient Outcome Pathway

ABSTRACTBackground: Nonadherence to medication therapy has been associated with poor health outcomes and increased health care costs. The literature describes pharmacists as key health care professionals in identifying and addressing nonadherence issues but does not explain how and why effective pharmacist-patient communication affects patients’ medication adherence. Previously published pathways used in linking effective physician-patient communication to patient outcomes are proposed for the context of pharmacist-patient communication. Objectives: To develop preliminary steps in a pharmacist communication – patient outcome pathway, adapted from a physician-patient communi-cation pathway,Methods: This longitudinal descriptive study, which took place in a large quaternary hospital, involved hospital pharmacists and patients. Patients’ assessment of pharmacist communication behaviours and reporting of patient satisfaction occurred after the pharmacist-patient consultation. Medication-taking behaviour questionnaires were administered before the consultation and again 4 weeks after discharge. Developing the preliminary pathway (based on previously established physician communication pathways) involved 2 steps, with investigation of the following associations: (1) between patient-reported effective communi-cation by pharmacists, as per the Communication Accommodation Theory (CAT), and patient satisfaction; and (2) between patient-reported pharmacist communication and satisfaction and patients’ medication-taking behaviour.Results: Twelve pharmacists and 48 patients participated. For step 1, almost all patient-reported pharmacist communication behaviours were positively correlated with patient satisfaction statements. Strong associations between CAT-related pharmacist communication behaviours and patient satisfaction highlighted the pharmacists’ behaviours that are important to patients and necessary for effective conversations to take place. In step 2, there were fewer correlations of medication-taking behaviour indices with pharmacist communication behaviours and patient satisfaction.Conclusions: This study showed how a preliminary pharmacist communication – patient outcome pathway could be successfully adapted from existing physician communication pathways. Such pathways provide an initial platform upon which future pharmacist communication – patient outcome research can be built.RÉSUMÉContexte : Le non-respect de la pharmacothérapie a été associé à de maauvais résultats sur la santé et à une augmentation des coûts des soins de santé. La documentation actuelle décrit les pharmaciens comme étant les professionnels de la santé les mieux placés pour déceler les problèmes de non-respect de la prise de médicaments et pour y répondre. Toutefois, elle n’explique pas comment ni pourquoi une communication efficace entre le pharmacien et le patient incite le patient à respecter sa médication. Les parcours qui ont aidé les médecins à améliorer l’efficacité de la communication avec leurs patients sont désormais proposés aux pharmaciens dans le contexte de leur relation avec le patient. Objectifs : Développer les étapes préliminaires d’un parcours de communi -cation entre le pharmacien et le patient adapté à partir des résultats tirés du parcours de communication entre le médecin et le patient.Méthodes : Cette étude descriptive longitudinale, qui s’est déroulée dans un important hôpital de soins quaternaires, portait sur les pharmaciens d’hôpitaux et les patients. L’évaluation par les patients des comportements de communication des pharmaciens et le rapport sur la satisfaction du patient se sont déroulés après la consultation qui a eu lieu entre le pharmacien et le patient. Les questionnaires relatifs à la prise de médicaments ont été administrés avant la consultation et à nouveau quatre semaines après le congé hospitalier. L’élaboration du parcours préliminaire (basée sur les parcours de communication du médecin déjà établis) comportait deux étapes servant à examiner les associations suivantes : (1) le rapport qu’ont fait les patients sur l’efficacité de la communication des pharmaciens conformément à la théorie de l’accommodation de la communication (TAC) et la satisfaction du patient et (2) le rapport qu’ont fait les patients sur la communication des pharmaciens ainsi que leur satisfaction et la prise de médicaments des par les patients.Résultats : Douze pharmaciens et 48 patients ont participé à l’étude. Concernant la première étape, presque tous les patients ont rapporté que les comportements de communication des pharmaciens étaient positivement corrélés aux énoncés de satisfaction des patients. Les fortes associations entre les comportements de communication liés à la TAC du pharmacien et la satisfaction des patients mettaient en exergue les comportements des pharmaciens qui sont importants pour les patients et nécessaires pour accroître l’efficacité des conversations. Concernant la deuxième étape, les corrélations étaient moindres entre les indices de comportement liés à la prise de médicaments et les comportements de communication du pharmacien ainsi que la satisfaction du patient.Conclusions : Cette étude a démontré comment un parcours de communi -cation préliminaire entre le pharmacien et le patient peut être adapté avec succès à partir des résultats tirés des parcours de communication existants destinés au médecin. De tels parcours fournissent une plateforme initiale sur laquelle peuvent se développer les recherches futures servant à démontrer les résultats sur les patients de la communication du pharmacien