Lec.(3rd) Patient-Centered Communication in Pharmacy Practice.pdf.pdf

Patient-Centered Care * The pharmacist's role has transitioned from a "distribution- centered" or "task-centered" practice to "patient-centered" care (clinical pharmacy) * Patient-centered care : Is the practice of caring for patients in ways that are meaningful and valuable t...

Patient-Centered Care * The pharmacist's role has transitioned from a "distribution- centered" or "task-centered" practice to "patient-centered" care (clinical pharmacy) * Patient-centered care : Is the practice of caring for patients in ways that are meaningful and valuable to the individual patient. It includes: - Listening to patients. - Educating them about their medications , and - Involving patients in their care. * Effective communication is central to meeting these patient care responsibilities in the practice of pharmacy. On the other hand, poor communication could result in one of the most common medical issues : non-adherence.  Patient-Centered Care Non-adherence * As health care professionals, we often incorrectly assume that because a prescription is written and dispensed, the patient will take it as instructed. * Nonadherence has been described as a "worldwide problem of striking magnitude," with rates ranging from 25% to 50% ! * Patients oftentimes intentionally decide to ignore advice regarding medication therapy. - Most often cited reasons for nonadherence include: (a) Lack of motivation (b) Patients’ wrong beliefs about taking medications. This is why patient-centered care and including patients in their health care decision-making is important.  Five Dimensions of Patient-Centered Medical Care Characteristics of an effective patient-centered medical care : (1) Understanding all aspects of the patient's illness experience: the social, psychological, and biomedical factors (2) Perceiving each patient as a person; understand the patient's unique experience of illness and the "personal meaning" it entails (3) Allowing patients to be actively involved in dialogue and in the decision-making surrounding treatment (4) Building a “trusting relationship" with patients by incorporating patient perceptions of the acceptability of interventions in treatment plans, and defining mutually agreed-upon goals for treatment. (5) Development of self-awareness of his or her (i.e. pharmacists) personal effects on patients and how his or her own responses to patients may affect patient behavior  The Pharmacists' Patient Care Process (PPCP) 1 5 2 * In response to the need for a consistent approach in delivery of patient care across the pharmacy profession, the Pharmacists' -Patient Care Process (PPCP) has been 3 established. 4 * PPCP include five steps as shown in the figures. - In the center of the circle figure is the patient-centered care), and key important elements in carrying out these responsibilities are communication, documentation, and collaboration. - As shown in the figure, communication plays an integral role in every step of this process  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 trusting relationship between you and your patients. (2) It provides the exchange of information necessary to assess your patients' health conditions, reach decisions on treatment plans, implement the plans, evaluate the effects of treatment on your patients' quality of life, and enhance patient safety. * Studies have shown that many patients don’t report adverse drug reactions to their health care providers. This is attributable to : (1) Health care providers who do not inquire about problems with drugs (2) Patients who dismiss the seriousness of side effects or.. (3) Patients who do not want to be seen as complaining to physicians as about treatments prescribed for them.  Importance of Communication in Meeting Your Patient Care Responsibilities * The purpose of the relationship is to achieve mutually understood and agreed upon goals for therapy that improve your patients' quality of life. - The goal is changed from providing patients with drug information to a goal of assuring that patients understand their treatment in order to take medications safely and appropriately. - The goal is not to get patients to do as they are told (i.e., comply) but to help them reach intended treatment outcomes. - Providing information or trying to improve adherence must each be seen as a means to reaching a desired outcome rather than being an end in itself.  Encouraging a More Active Patient Role in Therapeutic Monitoring * The information a patient provides you as part of therapeutic monitoring is essential to assuring that treatment goals are being met. - While INR or HbAlc values may provide the comfort of a "scientific" basis for therapeutic monitoring, for many chronic conditions you must rely on patient report of response to treatment. Example 1: Treatment of depression and pain, have only patient self-report as the basis of evaluation of response to therapy. Example 2: Many other common chronic conditions such as asthma, angina, gastroesophageal reflux disease ( GERD ), epilepsy, and arthritis also rely heavily on patient report of symptoms.  Encouraging a More Active Patient Role in Therapeutic Monitoring * Providers can facilitate more active participation of patients in the decision-making process by: (1) Educating patients how to find information about drugs (2) Clarifying their understanding of treatment goals (3) Encouraging patients to speak up if they have questions or concerns (4) Encouraging patients to educate themselves about their illness (5) Encouraging patients to use health care organizations that have been carefully checked out * Studies have shown that patients who actively participate in decisions related to their drugs had better response outcomes. A Patient-Centered View of the Medication Use Process Patient-only involvement Patient and health care providers involvement  A Patient-Centered View of the Medication Use Process * Data indicate that large numbers of prescriptions are written that are never filled. * Failure to initiate prescribed therapy may be caused by: (1) Economic constraints. - Approximately 20% of people report that they take less prescr iption medication than recommended because of cost. (2) A lack of understanding of the purpose of the recommendation - This might reflect a failure in the communication process between the patient and the health care provider. - Not understanding the purpose of the treatment could result in patients altering their drug treatment regimens, or patients discontinuing drug therapy. E.g., the wrong belief that a certain drug is meant to cure rather than only controlling the symptoms of a chronic condition would result in stopping the drug.  A Patient-Centered View of the Medication Use Process * When possible, you should encourage patients to share their experience with therapy because : (1) They may have unanswered questions (2) They may have misunderstanding or misperceptions (3) They may experience problems related to therapy and not tell you (4) They may monitor their own responses to treatments without involving you (5) They may make their own decisions regarding therapy (6) They may not reveal key information to you unless you initiate a dialogue  A Patient-Centered View of the Medication Use Process Factors influencing the patient decision to follow up with providers: (1) The nature of their relationships with you and other providers. (2) The degree to which patients feel "safe" in confiding difficulties or concerns. (3) The skill of providers in eliciting patient perceptions, and the extent to which a sense of "partnership" has been established regarding treatment decisions.  Real-life examples showing why patient-centred communication is so crucial Case 1: Case 2: A 77-year-old was prescribed a fentanyl patch, A 73-year-old man received a handwritten prescription and a friend picked up the prescription. No for amlodipine. He filled it at the pharmacy, and shortly educational materials or instructions were after taking the first dose, he felt nausea, had sweating, provided to the friend. The friend helped the patient and had a persistent blurry vision. place the patch on the site of the pain when required. The patient used to sleep besides a heater After 2 weeks, and it was discovered that the tablets due to the cold whether. looked different than their original appearance and that amitriptyline was filled instead of amlodipine. After not hearing from the patient for 2 days, the friend went to her apartment and found her dead next to the heater! 1- Poor written communication by the physician. It was then uncovered that this has occurred due to 2- Poor verbal communication by the pharmacist as he fentanyl-induced toxicity as fentanyl absorption is doesn’t ask the patient why he is using this drug. increased after exposing the patch to heat. 3- Poor verbal communication by the patient as he Poor verbal and or written communication between doesn’t question the pharmacist why the drug looks the physician/the pharmacist and the patient. different this time compared to previous prescriptions. Case 3: A patient was experiencing worsening rheumatoid arthritis (RA) symptoms, so, to address it, he doubled his weekly methotrexate dose from 10 to 20 mg without his provider's knowledge hoping to improve his symptoms. He was also finishing up a course of an antibiotic ( amoxicillin) for an infection. The next day, the rheumatologist prescribed an additional disease-modifying antirheumatic drug, leflunomide. Within the next week, the patient was admitted to the hospital with pancytopenia (a methotrexate-induced ADR). He was treated aggressively but died. 1- Poor verbal communication by the patient as he doesn’t inform the physician that he has increased the dose due to poor response a new RA drug was added increased toxicity due to both the increased dose and adding a new drug. 2- Poor verbal communication by the physician as he doesn’t ask the patient about other drugs he is using. Amoxicillin increased blood levels of methotrexate further increase of toxicity. Case 4 While filling a prescription for a child, the pharmacist determines that according to the refill history of the child's maintenance asthma medication (Fluticasone), they haven't filled it in a while. When the child's mother picks up the steroid script, the pharmacist asks her about the maintenance medication, and she says they can't afford it because they are currently facing a devastating situation and the medication is too expensive. The pharmacist has recommended a cheaper alternative after discussing this issue with the physician. Good verbal communication by the pharmacist with both the patient and the physician has improved therapeutic care for this patient.