Lec 1&2
Patient-Centered Communicationin Pharmacy Practice
Communication skill: is one of the pharmacist mission which aims to develop a conventional relationship between pharmacist and the patients in which the information is exchanged, hold in confidence and used to optimize patients care through appropriate dug therapy and hence results in improve therapeutic outcomes.
Pharmacist have the potential to contribute even more to improved patient care through efforts to
1.reduce medication errors and
2.improve the use of medications by patients.
3.Pharmacists must participate in activities that enhance patient adherence and the wise use of medication
Pharmacists’ Responsibility in Patient Care
----------------------------------------------------------The incidence of preventable adverse drug events and the cost to society associated with medication-related morbidity and mortality is of growing concern
Medication-related errors are among the most prevalent errors in medical care
The potential of pharmacists playing a pivotal role in reducing the incidence of both medication-related errors and drug-related illness is also receiving increased attention.
Pharmaceutical care can be defined as:
“the responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient’s quality of life”
Pharmacist′s responsibility increased in ensuring that Patient-centered care depends on
your ability to develop trusting relationships with patients,
to engage in an open exchange of information,to involve patients in the decision-making process regarding treatment, and
to help patients reach therapeutic goals that are understood and endorsed by patients as well as by health care providers.
Importance of Communication in Meeting Your Patient Care Responsibilities
-----------------------------------------------------------------------------The communication process between you and your patients serves two primary functions:
1.It establishes the ongoing relationship between you and your patients; and
2.It provides the exchange of information necessary to assess your patients’ health conditions, reach decisions on treatment plans, implement the plans, and evaluate the effects of treatment on your patients’ quality of life.
An effective relationship forms the base that allows you to meet professional responsibilities in patient care.
The purpose of the relationship is to achieve mutually understood and agreed upon goals for therapy that improve your patients’ quality of life.. Your goal, for example, is changed from providing patients with drug information to a goal of ensuring that patients understand their treatment in order to take medications safely and appropriately. Your goal is not to get patients to do as they are told. but to help them reach intended treatment outcomes.
What is Patient-Centered Care?
We can describe five dimensions of patient-centered medical care:1. Practitioners must understand the social and psychological as well as the biomedical factors that relate to the illness experience of a patient.
2. Providers must perceive the “patient as person.” This requires understanding your patients’ unique experience of illness and the “personal meaning” it entails.
3. Providers must share power and responsibility..
4. Providers must promote a “therapeutic alliance.” This involves incorporating patient perceptions of the acceptability of interventions in treatment plans, defining mutually agreed upon goals for treatment, and establishing a trusting, caring relationship between you and your patients.
5. Providers must be aware of their own responses to patients and the sometimes unintended effects their behaviors may have on patients.
Providing Patient-Centered Care
Understanding Medication Use from the Patient Perspective
Models of the prescribing process that are “practitioner-centered” have primarily focused on decisions made and actions taken by physicians and other health care providers. The patient is “acted upon” rather than being viewed as an active participant who makes ongoing decisions affecting the outcomes of treatment..One of our professional conceits seems to be that prescribing and dispensing a drug are the key decisions in the medication use process. However, in most cases, it is the patient who must return home and carry out the prescribed treatment.
The degree of autonomy that is possible with medication therapy makes it likely that patients will make decisions and assert control over treatment in various ways. Many patients make autonomous decisions to alter treatment regimens—decisions that may be made without consultation or communication with you or other health care providers.
. Ignorance of patient-initiated decisions on medication use, in turn, makes it difficult for health care professionals to accurately evaluate the effects of drug treatment.
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. The medication- use process for patients beings when the patient perceives a health care need or heath –related problem. The patient then interprets the perceived problem. This interpretation is influenced by a host of psychological and social factors unique to the individual.The practitioner’s skill in communicating information about the diagnosis may alter or refine the patient’s conceptualization
of her illness experience, making patient understanding more congruent with that of the health care provider.
Once the health care provider reaches a professional assessment or diagnosis of the patient’s problem based on patient report, patient examination, and other data, she or he makes a recommendation to the patient. If the recommendation is to initiate drug treatment, the patient may or may not carry out the recommendation. Some of these patient decisions may, in fact, reflect a failure in the communication process between the patient and the health care provider.
When patients do accept the recommendations to initiate drug treatment, they can do so only to the best of their ability as they understand the drugs are intended to be taken. For many patients, medication taking includes misuse caused by misunderstanding of what is recommended or by unintended deviations from the prescribed treatment regimen (e.g., doses are forgotten). Alternatively, patients may administer the drug but with intentional modifications of the regimen.
other providers when follow-up is expected, This follow-up contact occurs during revisits with a physician or refills of prescriptions from pharmacists. The nature of the their relationships with you and other providers, the degree to which patients feel “safe” in confiding difficulties or concerns, the skill of providers in eliciting patient perceptions, and the extent to which a sense of “partnership” has been established regarding treatment decisions—all influence the patient decision to re contact providers.
These factors also influence the degree to which medication-taking practices are reported and perceptions shared. Regardless of how completely patients report their experience with therapy when they re contact providers, the provider will make a professional assessment of patient response to treatment based on what the patient does report and/or laboratory values and other physiological measures. This assessment will lead to recommendations to continue drug treatment as previously recommended,
to alter drug treatment (i.e., to change dose, change drug, add drug), or to discontinue drug treatment.
Analysis of the medication-use process highlights several things:- First, the decision by you and other providers to recommend or prescribe drug treatment is a small part of the process.
Second, patients and professionals may be carrying out parallel decision making with only sporadic communication about
these processes.
Third One of the aims of the communication process should be to make the understanding of the patient and you regarding the disease, illness experience, and treatment goals as congruent as possible. . The key is to maximize patient outcomes by using patient-centered communication skills.