Do community pharmacists actively engage elderly patients in the dialogue? Results from pharmaceutical care consultations

Quantitative analysis of communication changes in online medication counseling using the Roter Interaction System

BACKGROUND

Quantitative analysis and objective evaluation of communication play an important role in medical communication education. In the process of developing an online methodology for medication counseling practice, we felt the necessity of conducting a quantitative evaluation to enhance its effectiveness.

OBJECTIVES

This study aimed to quantitatively evaluate the communication in each scenario to comprehensively identify the differences between face-to-face and online communication in medication counseling practicum. In addition, we examined how patient satisfaction changes between face-to-face and online interactions.

METHODS

Face-to-face and online role-playing were conducted between simulated patients (SPs) and students acting as pharmacists, and their dialogues were videotaped. The utterances in each recorded dialogue were categorized and analyzed by the Roter interaction analysis system (RIAS). The Japanese version of the Medical Interview Satisfaction Scale (MISS-21J) responses of the SPs were analyzed for the patient satisfaction survey.

RESULT

The results of the RIAS analysis revealed that the socio-emotional category appeared significantly more frequently in face-to-face communication, with more utterances that were more attuned to the feelings of the other person and more considerate of his or her feelings. The ratio of the number of utterances between students and SPs suggested that the communication was more interactive.

CONCLUSION

Based on the respective communication tendencies may have led to higher satisfaction in face-to-face than in online patient satisfaction surveys, less anxiety about illness and medications, and easier trusting relationships. Since it is difficult to grasp the mood of the other party and to open up to them due to the lack of nonverbal information in online dialogue, it is necessary to be more conscious of conversations that capture the feelings of patients in online medication counseling.

Participation of pharmacists and patients in web-based pharmaceutical care consultation based on MEDICODE

BACKGROUND

The participation of providers and patients in medical communication is the core element of shared decision making. Furthermore, web-based pharmaceutical care consultation is increasingly necessary, welcomed and popular.

OBJECTIVE

This study aimed to analyze the participation of pharmacists and patients in web-based pharmaceutical care consultation, so as to form the promotion strategy for both parties' participation.

METHODS

Data of pharmacist-patient encounters was obtained from the online platform 'Good Doctor Website' from March 31, 2012 to June 22, 2019. MEDICODE was employed to analyze the participation of pharmacists and patients in web-based pharmaceutical care consultation using dialogue ratio, the preponderance of initiative, and dialogical roles (information provider, listener, instigator and participant).

RESULTS

This study included 121 pharmacist-patient encounters which discussed 382 specifically named medications. On average, 3.75 specific themes were discussed per medication. Among the 29 specific themes observed, 16 were initiated primarily by patients and 13 by pharmacists, 22 were primarily monologue, 6 were primarily dialogue, and 1 was a combination of the two. Pharmacists and patients were information providers or listeners in most content theme categories, such as possible main effect, possible adverse effect, instructions, warnings, adherence, designation, and observed adverse effect.

CONCLUSIONS

Pharmacists and patients exchanged less drug-related information in web-based pharmaceutical care consultation. The exchange had more patient-dominated behaviors and more of a monologue. Furthermore, pharmacists and patients were mainly information providers or listeners in communication. The participation of both parties was insufficient.

Clinical Communication Within Hospital Pharmacy Practice: Exploring Pharmaceutical Oncological Consultations

This exploratory study aimed to identify communication trends typical of pharmacists' clinical communication in the context of hospital consultations. A cross-sectional design was used to investigate the pharmacist-patient exchange, applying the Roter Interaction Analysis System (RIAS). Communication variables and RIAS composites were assessed, including therapeutic information complexity, estimated through the ad-hoc score CTICS (Cancer Therapy Information Complexity Score). The study comprised 13 consultations of cancer patients with one female pharmacist, of which 6 included a patient family member, lasting on average 22.74 minutes and presenting repeated or overlapping consultation phases. The pharmacist's talk dominance reached 53.49%, slightly higher in dyadic consultations (U = 6.0, p = .032), and with an overall predominance of closed-ended questioning (W = 81.0, p = .013). Patients' questioning on biomedical issues was higher in dyadic consultations. The level of the pharmacist's rapport-building with the relative was higher when the patient's age was ≥80 years. Several strong correlations, both positive and negative, were found between composites, including between patient positive rapport-building and relative lifestyle/psychosocial information giving (Rho = -0.971, p = .001). Pharmaceutical consultations seem to be lengthier than other hospital practitioners' interviews, indicating a lack of  clear organization and flow, thus challenging their efficiency regarding therapy management. Still, several positive communication features were found regarding the pharmaceutical care of older cancer patients. Further studies are needed, involving larger samples and other hospital consultation settings.

Effects of Demographic Characteristics and Consumer Behavior in the selection of Retail Pharmacies and Over-the-Counter Medicine

Aim

The study aimed to provide new insights into consumer behaviour by identifying the key demographic factors that influence the choice of pharmacy and over-the-counter (OTC) medicine.

Materials and Methods

A cross-sectional study was conducted in an urban area (Thessaloniki, Greece), surveying a convenience sample of 314 consumers with a structured questionnaire. Data analysis was conducted using the chi-square test, one-way analyses of variance (ANOVAs) and Spearman's rho correlation coefficient.

Results

Respondents with a lower educational level and retired consumers tended to make their purchases in a single pharmacy (p < 0.001). Older participants were more likely to consider the pharmacy staff and additional services to be important factors (p < 0.01). Students were the only group to prefer a formal relationship with the pharmacy staff (p < 0.001). Participants with a lower educational level tended to know exactly what they would buy (p < 0.05), whereas women made more unscheduled purchases of OTCs (p < 0.05). Respondents with a higher income assigned more importance to the product's country of origin (p < 0.05) and manufacturing company (p < 0.01) and less importance to the pharmacist's opinion than those of a lower income (p < 0.05).

Conclusions

The educational level, occupation and age of consumers have a marked effect in their selection of pharmacy, and along with gender and personal income, in their choice of OTC medicine. Our findings yield implications for the management of community pharmacies.

The utility of Conversation Analysis versus Roter's Interaction Analysis System for studying communication in pharmacy settings: a scoping review

OBJECTIVES

To compare the usefulness of the Roter Interaction Analysis System with Conversation Analysis (CA) for studying dynamic patient-pharmacist interactions within pharmacy practice. A scoping review was undertaken to identify all studies using Roter's method or CA to investigate patient-pharmacist interactions. The studies were then compared and contrasted for their methodological advantages and disadvantages.

KEY FINDINGS

In total, 31 studies met the inclusion criteria. Roter's method is effective in briefly describing patient-pharmacist interactions and can be used to measure the effect of training courses without consuming too much time. CA, although a time-consuming undertaking, looks at very specific features and the sequence of conversations including the dynamics of two-way interactions and can therefore be used to identify the source of conflict or misunderstandings. A flowchart showing the usefulness of both methods is suggested to help other researchers select the appropriate method(s) for their own research.

SUMMARY

Although both methods are effective for investigating patient-pharmacist interactions independently, using them sequentially could enable researchers to firstly identify how to make improvements (via CA), design relevant training and then investigate the impact of such training (via Roter's method) to enrich communications research.

Determinants of community pharmacists' information gathering and counseling practices during the management of minor ailments

Objective

To assess the determinants of community pharmacists' information gathering and counseling practices during the management of minor ailments in Qatar.

Method

A cross-sectional study of 305 community pharmacists was conducted with a pre-tested 27-item questionnaire. Bivariate logistic regression was used to identify the determinants of information gathering and counseling practices.

Results

The response rate was 92.5% (282/305). A majority of the respondents (68.1%) were males, within the age range of 31-40 years (55.3%), work for chains pharmacies (77.3%), and were predominantly of foreign nationalities (94.7%). Patients' identity (91.1%), age (92.2%), symptoms (92.6%) and duration of symptoms (89.3%) were most frequent information gathered, while dose (99%), frequency (97.8%), route of administration (95.7%), and duration of use (92.9%) were the most frequent counseling information. Median information gathering score was significantly higher in females and among community pharmacists in chain pharmacies (p < 0.05), while median counseling practice scores were significantly higher among in chain pharmacies (p < 0.05). Consultation time of 6-10 min (OR = 1.75, 95% CI: 1.02-3.0, p = 0.04) and female gender (OR = 2.10, 95% CI: 1.16-3.79, p = 0.01) were significant determinants of information gathering, while age group (31-40 years) (OR = 1.84, 95% CI: 1.05-3.22, p = 0.03) and consultation time (6-10 min) (OR = 2.24, 95% CI: 1.31-3.86, p = 0.003) were significant determinants of counseling practices.

Conclusion

The significant determinants of community pharmacists' Information gathering and counseling practices during the management of minor ailments were female gender and consultation time (6-10 min), and age group (31-40 years) and consultation time (6-10 min) respectively.

Management of common minor ailments in Qatar: Community pharmacists' self-perceived competency and its predictors

Studies focused on comprehensive assessment of self-perceived competency of community pharmacists to manage minor ailments are scanty despite that self-perceived competency is a valid determinant of task performance. The objectives of the study were to assess community pharmacists’ self-perceived competency to manage fourteen common minor ailments in Qatar, and identify its significant predictors. A cross-sectional assessment of 307 community pharmacists was conducted with a pre-tested 20-item questionnaire. Self-perceived competency was assessed with nine elements on a scale of 1–10 (Maximum obtainable score: Each minor ailment = 90; each element = 140). Mann-Whitney U and bivariate logistic regression were used for data analyses. The response rate was 91.9% (282/307). The majority of the respondents were males (68.1%; 192/282), within the age range of 31–40 years (55.3%; 156/282). The minor ailments with the highest median competency score were constipation (76), and cold/catarrh (75) while travel sickness (69), and ringworm (69) had the lowest. The two condition-specific competency elements with the highest median score were recommendation of over-the-counter (OTC) medicines (115), and provision of instructions to guide its use (115). Ability to differentiate minor ailments from other medical conditions had the lowest median competency score (109). The significant predictors self-perceived competency were female gender (OR = 2.39, 95%CI: 1.34–4.25, p = 0.003), and working for chain pharmacies (OR = 2.54, 95%CI: 1.30–4.96, p = 0.006). Overall, Community pharmacists’ self-perceived competency was adequate for majority of the common minor ailments, and it was highest for constipation and cold/catarrh, and specifically for the recommendation of OTC medicines and provision of instructions to guide its use. However, diagnostic ability to differentiate minor ailments from other medical conditions with similar features had the lowest median competency score. Female gender and working in chain pharmacies were the significant predictors of self-perceived competency to manage minor ailments.

Medication reviews in community pharmacy: a scoping review of policy, practice and research in Canada

Objectives

This scoping review aims to systematically map the empirical evidence on publicly funded medication reviews provided by community pharmacists in Canada and identify gaps that could inform future research directions.

Methods

We used a scoping review framework and PRISMA guidelines for Scoping Reviews to conduct the study. Three electronic databases were searched for papers published between January 2000 until August 2020. Data was charted on study characteristics, and a thematic synthesis was performed.

Key findings

Of 41 original studies included, most were conducted in Ontario (n = 21). Majority of the studies employed quantitative designs (70%). Five major themes identified were program uptake, patient health outcomes, stakeholder beliefs and attitudes, processes and collaboration and pharmacy workplace culture, which varied considerably. At the individual, organizational and policy levels, many factors were interrelated and influenced the implementation of reimbursed medication reviews by community pharmacists. Gaps in eligibility policy highlighted some patients who may have complex needs are excluded. Variation in clinical outcomes may relate to different types of medication review and pharmacist practice across Canada. Few researchers evaluated eligibility criteria, the impact of policy changes, strategies to engage patients and healthcare professionals, patient–pharmacist communication or compared practice models of medication reviews. About 12% of the research applied a theoretical framework.

Summary

Publicly funded medication reviews in Canadian community pharmacies reduce medication-related problems and potentially improve patient health outcomes. Future research and policies could consider addressing barriers and exploring models for sustainable delivery of high-quality medication reviews internationally.

Factors influencing patient participation in medication counseling at the community pharmacy: A systematic review

BACKGROUND

Findings document that patient participation in pharmacy encounters is associated with favorable outcomes. However, there is a need to understand factors that may enhance or hinder patient engagement and pharmacist counseling behaviors during their medication discussions. This review aims to: (1) identify barriers and facilitators for patient engagement in pharmacy consultations, (2) explore the relationship between patient factors (such as demographics and communication behavior) and subsequent pharmacist counseling behavior.

METHODS

A systematic review of literature using PRISMA guidelines examined studies published in English addressing influences on patient participation and the relationship between patient factors and pharmacist counseling behavior. Four databases were used - PubMed, CINAHL, PsycINFO, and Scopus. Findings were framed thematically within the constructs of Street's Linguistic Model of Patient Participation in Care (LM).

FINDINGS

Fifty studies from 1983 to 2019, including 37 using self-reported data, were identified. Patient involvement in patient-pharmacist communication was influenced by enabling factors such as patient knowledge, communication skills, and pharmacy environment. Predisposing factors for participation ranged from patients' beliefs and past experiences to demographic characteristics such as gender and age. Pharmacists' participative behavior with patients was positively associated with patients' engagement and perceived patient cues in the conversation.

CONCLUSION

This systematic review identified predictors of patients' engagement in pharmacy encounters drawing on LM framework. Various predisposing factors, enabling factors, and pharmacist' responses impacted patients' willingness to actively participate in medication counseling at community pharmacies. Equally important, studies documented considerable impact by patients on pharmacists' counseling behavior. Pharmacy encounters should no longer be viewed as controlled simply by pharmacists' expertise and agendas. Patient characteristics and factors such as patient question-asking and expectations also appear to be associated with and influence patient-pharmacist interpersonal communication. Additional research needs to address the identified facilitators and barriers to enhance patient participation and pharmacist counseling behavior.

Pharmacy Technicians' Perception About Symptoms and Concerns of Older Patients Visiting Pharmacies: A Cross-Sectional Study

Purpose

Older patients are still not sufficiently integrated into multidisciplinary care concepts including geriatric and palliative care. They do, however, regularly visit pharmacies to fill prescriptions or to buy self-medication. Thus, they have frequent contact with pharmacy technicians (PTs), who are widely involved in counselling in Germany. However, it is not known whether geriatric symptoms are recognized by PTs and to what extent older patients use their pharmacy to address geriatric or palliative concerns. This study aimed to investigate PTs' impression of older patients' symptoms, geriatric and palliative concerns in consultations, as well as multidisciplinary collaboration.

Patients and Methods

We conducted a cross-sectional study in April-May 2019. Using a self-administered questionnaire, PTs were asked about (i) geriatric symptoms, (ii) geriatric and palliative concerns older patients expressed in routine consultations, (iii) supposed reasons for inadequate care, and (iv) PTs' desire for multidisciplinary cooperation.

Results

(i) The 5 most common symptoms the 339 participating PTs recognized in the community pharmacy were pain, insomnia, restricted mobility, eye disorders, and constipation. (ii) The three most frequently addressed non-drug-related geriatric palliative concerns were mental strain, loneliness, and mourning. (iii) As reasons for inadequate patient care, PTs predominantly mentioned patient-related reasons (299 of 518 reasons, 58%). (iv) 85% of the PTs desired closer cooperation with general practitioners, 84% with nursing services and 39% with palliative physicians.

Conclusion

PTs frequently saw older patients visiting the pharmacy who suffer from a variety of symptoms. PTs were additionally confronted with diverse geriatric or palliative concerns. We deduce, first, a need for PT training in geriatric and palliative care. Second, multidisciplinary care concepts and research should include pharmacies because they seem to be a low-threshold contact to older patients, who might need access to adequate care.

Pharmacist-Patient Communication in Prostate Cancer as a Strategy to Humanize Health Care: A Qualitative Study

Background:

Pharmacists require effective communication skills to enhance involvement in patient care. Nevertheless, there are few qualitative studies exploring “how” pharmacist–patient communication occurs and none targets patients with cancer.

Objective:

To describe the perceptions of outpatients with prostate cancer regarding the communication process during clinical pharmacy service in a community pharmacy.

Methods:

A qualitative study was performed from semistructured interviews with 10 patients. These interviews were audiotape-recorded and transcribed comprehensively, and the data were analyzed using content analysis. The validation of the categories and registration units was made by 2 independent authors and reviewed by a third author.

Results:

Three categories were established from the content analysis (general perceptions of the pharmacist–patient communication, potentialities of effective communication, and points for improvement). Communication is a complex process and involves, in addition to information exchange, the sharing of thoughts, desires, and fears. Our findings hold that effective communication skills by pharmacist can help patients validate their concerns, develop a trusting patient–pharmacist relationship, address drug therapy problems, and lead to better health outcomes.

Conclusion:

Pharmacist–patient communication is an important strategy for humanized practice. This allows the pharmacist to see beyond an individual with health problems to a human being with particularized needs.

Community pharmacy customer segmentation based on factors influencing their selection of pharmacy and over-the-counter medicines

Background

Within the competitive pharmacy market environment, community pharmacies are required to develop efficient marketing strategies based on contemporary information about consumer behavior in order to attract clients and develop customer loyalty.

Objectives

This study aimed to investigate the consumers' preferences concerning the selection of pharmacy and over-the-counter (OTC) medicines, and to identify customer segments in relation to these preferences.

Methods

A cross-sectional study was conducted between February and March 2016 on a convenient quota sample of 300 participants recruited in the metropolitan area of Thessaloniki, Greece. The main instrument used for data collection was a structured questionnaire with close-ended, multiple choice questions. To identify customer segments, Two-Step cluster analysis was conducted.

Results

Three distinct pharmacy customer clusters emerged. Customers of the largest cluster (49%; 'convenience customers') were mostly younger consumers. They gave moderate to positive ratings to factors affecting the selection of pharmacy and OTCs; convenience, and previous experience and the pharmacist's opinion, received the highest ratings. Customers of the second cluster (35%; 'loyal customers') were mainly retired; most of them reported visiting a single pharmacy. They gave high ratings to all factors that influence pharmacy selection, especially the pharmacy's staff, and factors influencing the purchase of OTCs, particularly previous experience and the pharmacist's opinion. Customers of the smallest cluster (16%; 'convenience and price-sensitive customers') were mainly retired or unemployed with low to moderate education, and low personal income. They gave the lowest ratings to most of the examined factors; convenience among factors influencing pharmacy selection, whereas previous experience, the pharmacist's opinion and product price among those affecting the purchase of OTCs, received the highest ratings.

Conclusions

The community pharmacy market comprised of distinct customer segments that varied in the consumer preferences concerning the selection of pharmacy and OTCs, the evaluation of pharmaceutical services and products, and demographic characteristics.

Determining counselling communication strategies associated with successful quits in the National Health Service community pharmacy Stop Smoking programme in East London: a focused ethnography using recorded consultations

OBJECTIVES

To determine communication strategies associated with smoking cessation in the National Health Service community pharmacy Stop Smoking programme.

SETTING

11 community pharmacies in three inner east London boroughs.

PARTICIPANTS

9 stop smoking advisers and 16 pairs of smokers who either quit or did not quit at 4 weeks, matched on gender, ethnicity, age and smoking intensity.

METHOD

1-3 audio-recorded consultations between an adviser and each pair member over 5-6 weeks were analysed using a mixed-method approach. First a content analysis was based on deductive coding drawn from a theme-oriented discourse analysis approach and the Roter Interaction Analysis System. Core themes were identified through this quantification to explore in detail the qualitative differences and similarities between quitters and non-quitters.

RESULTS

Quantitative analysis revealed advisers used a core set of counselling strategies that privileged the 'voice of medicine' and often omitted explicit motivational interviewing. Smokers tended to quit when these core strategies were augmented by supportive talk, clear permission for smokers to seek additional support from the adviser between consultations, encouragement for smokers to use willpower. The thematic analysis highlighted the choices made by advisers as to which strategies to adopt and the impacts on smokers. The first theme 'Negotiating the smoker-adviser relationship' referred to adviser judgements about the likelihood the smoker would quit. The second theme, 'Roles of the adviser and smoker in the quit attempt', focused on advisers' counselling strategies, while the third theme, 'Smoker and adviser misalignment on reasons for smoking, relapsing and quitting', concerned inconsistencies in the implementation of National Centre for Smoking Cessation and Training recommendations.

DISCUSSION

Advisers in community pharmacies should use the advantages of their familiarity with smokers to ensure appropriate delivery of patient-centred counselling strategies and reflect on the impact on their counselling of early judgements of smoker success.

A qualitative study exploring medication management in people with dementia living in the community and the potential role of the community pharmacist

Background

The prevalence of dementia is increasing rapidly. People with dementia may be prescribed complex medication regimens, which may be challenging for them and any carers involved to safely manage.

Objective

To describe and understand the key challenges, in relation to medication issues, experienced by people with dementia and their informal carers dwelling in the community and the potential role of community pharmacists.

Design

Qualitative semi‐structured interviews.

Participants

People with dementia, informal carers and health and social care professionals (HSCPs).

Results

Thirty‐one participants (eleven informal carers, four people with dementia and sixteen HSCPs) were interviewed. Three key themes were identified: the key challenges, improving medication management and the role of pharmacists. The caring role commonly included responsibility for medication management which created both practical problems and an emotional burden. This burden was worsened by any difficulty in obtaining support and if the person with dementia was on a complex regimen. Participants believed that the process could be improved by coordinated and on‐going support from HSCPs, which should focus on the informal carer. Medication reviews, particularly when conducted in the home environment, could be helpful.

Conclusion

Medication management for people with dementia living in the community is a complex process, and informal carers have a key role, which they frequently find challenging. Community pharmacists could have an enhanced role in this area, but would need to work within a more multidisciplinary environment outside the pharmacy.

How pharmacist-patient communication determines pharmacy loyalty? Modeling relevant factors

BACKGROUND

Portuguese community pharmacies provide pharmaceutical services, such as therapeutic outcomes follow-up, supplemented by relevant point-of-care testing that require continuity of provision to be effective.

OBJECTIVES

To identify factors of technical and communication nature that during a patient interview contribute to patients' loyalty.

METHODS

A cross-sectional descriptive study, with a purposive sample of community pharmacies providing pharmaceutical care, was conducted. Patient interviews were taped and transcribed verbatim. Duration, segments and utterances were identified and time stamped, using a previously validated coding scheme. To identify predictors of loyalty, logistic regression analyses were performed.

RESULTS

From 59 interviews, participants' average age was 65.7 years and 42 (71.2%) were female; 45 (76.3%) interviews were classified as outcomes measurements and 14 (23.7%) as pharmaceutical consultations, with 33.2% of the patients booking a following appointment. The significant items to explain loyalty were associated with lifestyle and psychosocial exchange, age of the patient, and the presence of all interview segments (i.e. a complete consultation).

CONCLUSION

Contrary to common professional beliefs and practice orientation it would appear that pharmacists' technical skills are not the essential factors that promote patients' loyalty needed for continuity of care, at least in the same extent as the social and lifestyle-related content of the exchange. Pharmaceutical care education should focus on relational skills as much as on medication-related competencies.