Facilitators and Barriers to Pharmacists' Patient Communication: The Pharmacist Profession, the Regulatory Framework, and the Pharmacy Undergraduate Education

Worldwide, the role of the community pharmacist is changing from distribution of medicines towards being a patient-centered profession and putting the patient and not the medicine in the center. Ideally, pharmacists use their specialized health and pharmacotherapeutic knowledge along with communication skills. This professional development involves a complex interplay between community pharmacists, the regulatory framework, and the pharmacy undergraduate education among others. The overall aim of this thesis was to explore, in the Nordic setting, how community pharmacists, the regulatory framework, and the pharmacy undergraduate education have responded to the shift in focus towards the increased communicative role of the pharmacists. The specific aims of this thesis were 1) to explore Norwegian community pharmacists’ motivation and perceived responsibility regarding role development and involvement in patient-centered care; 2) to describe society’s expectations of community pharmacist-patient communication around medications as expressed by the states in the Nordic legislation, economic incentives, and authority control; 3) to map communication skills building in pharmacy curricula in order to find ways to potentially improve the training by 3a) exploring current practice and 3b) course leaders’ opinions regarding teaching of patient communication skills in Nordic pharmacy schools; 4) to describe Nordic pharmacy students’ opinions of their patient communication skills training, and the association between course leaders’ reports of patient communication skills training qualities and the students' perceptions of their training. Secondary was to determine what factors influence these associations; and 5) to explore Nordic pharmacy students’ attitudes to communication skills learning, as well as the associations with various student characteristics. In order to explore the study aims, focus groups and a document review were utilized to address Aims 1 and 2. For Aims 3-5, two questionnaire studies were undertaken. Paper I showed a gap between the pharmacists day-to-day work as ‘distributors’ and their ideal tasks of patient care in the pharmacy. The pharmacists discussed, e.g., the patients, doctors, pharmacy chains, or time constraints as reasons for not claiming a more active role in patient’s medicine use and their role development. Paper II identified a general, but not very detailed, legislation on communication on prescription medicines during dispensing. Communication on medicines was not directly supported with economic incentives or effective control thereof. In Paper III it was shown that the pharmacy practical experience is the main period for patient communication skills training, and the training is often placed late in the education. During the five years of education, the teacher-led training varied from 6 to 92 hours, and few schools used experiential training methods. Most course leaders identified a need for larger focus on communication skills training. Paper IV showed that students with more experiential training methods and >20 hours of training were significantly more likely to report having received sufficient training (adjusted OR:4.20; 95% CI:2.03 to 8.69, p<0.001), and that the pharmacy school had contributed to their skills (adjusted OR:3.65; 95% CI:1.89 to 7.04, p<0.001) compared to students without such training. Paper V showed that Nordic pharmacy students in general had moderately positive attitudes towards learning communication skills and that such attitudes were associated with female gender (adjusted ß:0.42; 95% CI:0.20 to 0.63, p<0.001), newer types of pharmacy education (adjusted ß:0.81; 95% CI:0.63 to 0.98, p<0.001), students who thought their skills needed improvement (adjusted ß:0.50; 95% CI:0.30 to 0.71, p<0.001), and students who thought their communication skills were a result of their personality (adjusted ß: -0.24; 95% CI:- 0.44 to -0.04, p=0.017). The findings from this thesis imply that the pharmacists have positive beliefs towards the increased communicative role, the legislations are not hindering the role, but they are not supporting it either. Nordic pharmacy schools could have strengthened the role more. An overall conclusion is that the three factors need improvements and alignment if pharmacists’ communicative role is going to reach full potential in practice

Patients' attitudes towards using a question prompt list in community pharmacies

Objective: To explore patients' usage rate and perceived usefulness and benefits of a question prompt list (QPL) when collecting prescribed medication in community pharmacies. Methods: Data were collected in Swedish pharmacies using questionnaires and semi-structured interviews with patients. The Technology Acceptance Model (TAM) was used, and the outcomes were usage rate, factors impacting on use, and perceived ease of use, usefulness, and benefits of self-reported question-asking and self-perceived medication knowledge. Descriptive statistics and group comparisons were performed, and qualita-tive data were analyzed thematically with the TAM. Results: Out of 145 patients filling out the questionnaire, 72 (50.0%) reported they had used the QPL. Patients with new prescriptions and non-native Swedish speakers used the QPL more often (p = 0.03; p = 0.009, respectively). The QPL was quick to read (86.3%) and easy to understand (91.4%). Forty percent stated that they asked more questions, and self-reported users scored higher on self-perceived medication knowledge. In the interviews (n = 14), the QPL was described as an eye-opener as to what one could ask the pharmacist. Conclusions: Patients were willing to use a QPL in community pharmacies. Practice implications: A QPL in pharmacies might improve patients' engagement medication knowledge, as well as showcase the expertise of pharmacists

A Qualitative Study on Danish Student Pharmacists’ Attitudes Towards and Experience of Communication Skills Training

As the pharmacy profession evolves, good communication skills are vital for securing the safer and more rational use of medicines. Currently there is a lack of qualitative studies researching European student pharmacists&#8217; and their experience with communication skills training (CST). This qualitative study aimed to fill this gap by exploring Danish student pharmacists&#8217; attitudes towards, and experiences of, CST. Focus group interviews were conducted with a heterogeneous sample of Danish student pharmacists in 2016. Interviews were audio recorded, transcribed verbatim and analyzed inductively. Fifteen students participated in three focus groups. Five categories identified as key aspects were: professional communication vs. normal conversation, motivation to engage in training, how to learn communication skills, experience with CST and universities&#8217; role in teaching communication skills. In conclusion, there were both positive and negative attitudes towards CST among the participants. However, they had little experience with CST. Bloom&#8217;s taxonomy of the affective domain and Kolb&#8217;s experiential learning model appear to be useful in understanding students&#8217; attitudes towards CST. Pharmacy educators can use this study to structure and improve their CST curricula by knowing what influences students&#8217; attitudes towards CST