Exploring the use of patient feedback in pharmacy consultations

Backgrounds Patient feedback has received increased attention to enhance different healthcare services including consultations with healthcare professionals. There is currently a dearth of research on using patient feedback in assessing pharmacy consultations. The aim of this thesis was to explore the use of patient feedback in assessing hospital pharmacists’ consultation skills. Methods This thesis includes three studies; the first was a systematic review to identify patient feedback questionnaires regarding assessing consultation skills of healthcare professionals. The second was a think-aloud study to pre-test the suitability of using a questionnaire identified in the systematic review in a hospital pharmacy setting. A final study was undertaken to explore the feasibility of collecting patient feedback on hospital pharmacists’ consultation skills using the identified questionnaire. Results The systematic review identified twelve questionnaires, none used in the pharmacy setting. One questionnaire was more promising to be taken forward since it had more evidence in terms of its psychometric properties. Cognitive interviews conducted using the questionnaire indicated its potential suitability to assess hospital pharmacy consultations. Feasibility study reflected positive views regarding patient feedback and its role in enhancing consultations, as expressed by patients and pharmacists. Some barriers were encountered by pharmacists regarding the process, all of which maybe resolved by assigning an independent third person to collect patient feedback. Some suggestions given primarily from pharmacists indicated the questionnaire may need amendment to make it more relevant to the pharmacy setting. Conclusions This thesis provides an overview of patients’ and hospital pharmacists’ views about patient feedback and its role in enhancing pharmacists’ consultation skills. Several barriers were encountered with suggestions given on how the process could be improved. The thesis revealed many areas warranting further investigation, such as exploring the impact patient feedback may have on consultation development and the role of the organisation in supporting pharmacists

Exploring what patients think when answering the Interpersonal Skills Questionnaire (ISQ): A ‘think aloud’ study

Background: The Interpersonal Skills Questionnaire (ISQ) was developed to collect patient feedback on consultation skills of practitioners. However, it has not yet been evaluated with pharmacists. Objective: To explore the thinking process of patients as they completed the ISQ following a consultation with a pharmacist. Methods: A qualitative think aloud (TA) methodology was used to explore patients' thinking while completing the ISQ following a consultation with a pharmacist. The study was conducted in secondary care with outpatients ≥18 years old. Interviews were carried out in rounds and were informally analysed (i.e., by writing notes while listening to recordings) to identify any associated major problem(s). Discussions were held between researchers to determine whether changes were needed based on patients' comments. Results: Eight patients in total (50% females) participated in this study (mean age: 48 years). Three rounds of TA were conducted. Most items of the ISQ were interpreted similarly by all participants with no major problems necessitating refining the ISQ. Conclusions: Modification of the ISQ was unnecessary as interviews demonstrated no major problems with its use. The ISQ is thus a potentially suitable tool to collect patient feedback on pharmacists' consultations

The community pharmacy setting for diabetes prevention: views and perceptions of stakeholders

Background: Diabetes prevention programmes delay or prevent the onset of type 2 diabetes in people with pre-diabetes. To increase accessibility, national guidelines recommend delivering diabetes prevention programmes in primary care settings, including community pharmacy. This study aimed to explore the English community pharmacy setting as an option for delivering diabetes prevention services. Methods: Two focus groups and nine semi-structured interviews were conducted with stakeholders including, community pharmacists, general practitioners and commissioners. The topic guide was framed using the COM-B theoretical model for behaviour change to elicit practitioners’ capability, opportunity and motivation to engage with providing or referring to community pharmacy diabetes prevention services. Data were analysed thematically, and barriers/facilitators mapped to the COM-B framework. Results: Five themes were identified: ‘Pre-diabetes management and associated challenges’, ‘The community pharmacy setting’, ‘Awareness of community pharmacy services’, ‘Relationships and communication’ and ‘Delivery of community pharmacy services’. Community pharmacy was highlighted as an accessible setting for delivering screening and follow-on lifestyle interventions. Key factors for enhancing the capability of community pharmacy teams to deliver the interventions included training and appropriate use of skill mix. Delivering diabetes prevention services in collaboration with general practices was identified as key to the provision of integrated primary care services. Whilst financial incentives were identified as a motivating factor for delivery, service promotion to patients, public and healthcare professionals was perceived as crucial for enhancing engagement. Conclusions: This research highlights a role for community pharmacy in diabetes prevention. New service models should seek to integrate community pharmacy services in primary care to facilitate patient engagement and better communication with general practices

Patient feedback questionnaires to enhance consultation skills of healthcare professionals: a systematic review

Objective: To identify patient feedback questionnaires that assess the development of consultation skills (CSs) of practitioners. Methods: We conducted a systematic search using seven databases from inception to January 2017 to identify self-completed patient feedback questionnaires assessing and enhancing the development of CSs of individual practitioners. Results were checked for eligibility by three authors, and disagreements were resolved by discussion. Reference lists of relevant studies and open grey were searched for additional studies. Results: Of 16,312 studies retrieved, sixteen were included, describing twelve patient feedback questionnaires that were mostly designed for physicians in primary care settings. Most questionnaires had limited data regarding their psychometric properties, except for the Doctor Interpersonal Skills Questionnaire (DISQ). Most studies conducted follow-up, capturing positive views of practitioners regarding the process (n = 14). Feedback was repeated by only three studies, demonstrating different levels of improvement in practitioners’ performance. Conclusion: Identified questionnaires were mainly focused on physicians, however, to support using patient feedback, questionnaires need to be validated with other practitioners. Practice implications: Several patient feedback questionnaires are available, showing potential for supporting practitioners’ development. Valid questionnaires should be used with appropriate practitioners in developing more evidence for the impact they may have on actual consultations

Exploring the views of community pharmacists on patient feedback on their consultations

Objectives: To explore community pharmacists’ (CPs) views on patient feedback on their consultations. Methods: The study was conducted at community pharmacies in the East of England. Pharmacists employed at a large multiple pharmacy were invited to a telephone/face-to-face interview. Interviews were audio-recorded and thematically analysed. Key findings: Six pharmacists participated and interviews yielded four main themes. Pharmacists shared views on benefits of collecting feedback (e.g. improving their consultations), potential barriers (e.g. bias) and associated resolutions (e.g. using anonymous questionnaires). Peer feedback was also suggested. Conclusions: Patient feedback is welcomed by CPs and perceived useful for improving their consultations

Patient feedback on hospital pharmacists' consultation skills: A feasibility study using the interpersonal skills Questionnaire (ISQ)

Background: Improvement in practitioners’ consultation skills (CSs) can be driven by patient feedback, however, to date, no study has been conducted with reference to pharmacy consultations. The Interpersonal Skills Questionnaire (ISQ) is potentially appropriate for collecting patient feedback on pharmacists’ CSs. This study aims to explore the feasibility of collecting patient feedback on hospital pharmacists’ CSs using the ISQ, to identify the acceptability of the feedback process, and to identify methods to enhance the process in the future. Methods: The study was conducted in a teaching hospital, United Kingdom, between 2018 and 2019. A diverse sample of pharmacists with patient-facing roles was purposively selected. The study comprised three phases. Pharmacists collected feedback from patients following their consultation using the ISQ utilising a third person whenever possible (phase-1). Data analysis and individual report writing was conducted by a private company. Interviewing a sample of patient participants by telephone (phase-2), and interviewing pharmacists face-to-face after receiving feedback reports (phase-3). All interviews were transcribed verbatim and thematically analysed. The study received approval by the NHS Health Research Authority. Results: Six pharmacists were included. Of the 119 distributed ISQs, 111 were returned (response rate 93%). Patients were mostly recruited by their consulting pharmacists (72%, n = 80). All pharmacists and 14 patients were interviewed. Participants were positive about patient feedback and its role in enhancing CSs. Most did not encounter any problem with the process, however, some pharmacists struggled to find a third person. The ISQ was mostly viewed suitable to assessing pharmacy consultations. Some reports highlighted areas to improve (e.g. protecting patient’s privacy). Conclusions: Collecting feedback is feasible, acceptable and may enhance CSs, however, the process was associated with challenges such as finding a third person. Several measures should be considered to make the process more feasible within the hospital pharmacy setting