PATIENT-CENTERED

COMMUNICATION
IN PHARMACY
PRACTICE
Done by: Assis.Lec.
Lubab Tarek Nafea
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 OVERVIEW
In order to meet their professional responsibilities, pharmacists
have become more patient-centered in their provision of
pharmaceutical care. Pharmacists have increase their potential
to improve patient care …..who????
through efforts to reduce medication errors and improve the use
of medications by patients.
Using effective communication skill is essential in the provision
of patient care.
A study by Weingart (2005) found that, while 27% of patients
experienced symptoms they attributed to a new prescription,
many of these symptoms (31%) were not reported to the
prescribing physician.
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WHY IS PATIENT-CENTERED COMMUNICATION
SO CRUCIAL TO A PROFESSIONAL PRACTICE?
A 36-year-old man was prescribed a fentanyl patch to treat
pain resulting from a back injury. He was not informed that
heat could make the patch unsafe to use. He fell asleep with
a heating pad and died. The level of fentanyl in his
bloodstream was found to be 100 times the level it should
have been .
A patient prescribed Normodyne for hypertension was
dispensed Norpramin. She experienced numerous side
effects including blurred vision and hand tremors. Thus even
minimal communication between the pharmacist and patient
about the therapy would have prevented this medication error
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Pharmacists are accepting increased
responsibility in ensuring that patients avoid
adverse effects of medications and also reach
desired outcomes from their therapies. The
changing role of the pharmacist requires
practitioners to switch from a “medication-
centered practice” to “patient-centered care”.
As revealed above, it is not enough for
pharmacists to simply provide medication in
the most efficient and safest manner (i.e.,
focus on systems of drug order fulfillment).4
What else to do????

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Pharmacists must participate in activities that enhance
patient adherence and the wise use of medication .
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.
Effective communication is central to meeting these
patient care responsibilities in the practice of
pharmacy.
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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 .
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
have made for pharmaceutical care,{ which they define as
“the responsible provision of drug therapy for the purpose of
achieving definite outcomes that improve a patient’s quality
of life}

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Mission statements of professional pharmacy
associations have been changed in recent
years, thus The “patient-centered” role
envisioned by pharmacy mission statements
would afford pharmacists a value to society far
beyond that provided by their current “drug-
centered” role. The quality of the interpersonal
relationships pharmacists develop with patients
depends upon effective communication .

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 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.

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Establishing trusting relationships with your
patients is not simply something that is “nice to
do” but that is essentially peripheral to the “real”
purpose of pharmacy practice.
The quality of the patient–provider relationship
is crucial. An effective relationship forms the
base that allows you to meet professional
responsibilities in patient care.

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Even communication with your patients is not an
end but conversation between you and your
patient has a different purpose than
conversation between friends. Patient–
professional communication is a means to an
end—that of establishing a therapeutic
relationship in order to effectively provide health
care services that the patient needs.

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The purpose of the relationship is to achieve
mutually understood and agreed upon goals for
therapy that improve your patients’ quality of
life. Your activities must, therefore, be thought of
in terms of the patient outcomes that you help to
reach. 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.

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 WHAT IS PATIENT-CENTERED CARE?
The pharmacist must be able to:
1. Understand the illness experience of the patient
2. Perceive each patient’s experience as unique
3. Foster a more egalitarian relationship with patients
4. Build a “therapeutic alliance” with patients to meet
mutually understood goals of therapy
5. Develop self-awareness of personal effects on
patients

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 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. Drug therapy is the most ubiquitous of
medical interventions and, in ambulatory care, is largely
managed by the patient. 15
 ENCOURAGING A MORE ACTIVE PATIENT
ROLE IN THERAPEUTIC MONITORING
Pharmacists, could do more to help enable patients and their
families or care givers to take a more active role in monitoring
response to treatment. The information a patient provides you
as part of therapeutic monitoring is essential to ensuring that
treatment goals are being met. While Hemoglobin HB values
may provide the comfort of a “scientific” basis for therapeutic
monitoring, for many chronic blood such as anemia, conditions
you must rely on patient report of response to treatment.
Treatment of depression and pain, for example, have only
patient self-report as the basis of evaluation of response to
therapy. Many other conditions such as asthma, angina,
gastroesophageal reflux disease , epilepsy, and arthritis rely
heavily on patient report of symptoms.
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The patient report of symptomatic experience is critical to
monitoring, and have the beneficial effects on patient outcomes
of increased patient involvement in self-monitoring of
physiological indicators of treatment effectiveness.
E.g./Certainly, patient self-monitoring of blood glucose has
become standard practice in managing diabetes. In addition,
blood glucose awareness training programs (BGAT) teach
patients to recognize signs of both hyperglycemia and
hypoglycemia.
Programs to increase patient participation in monitoring of
coagulation therapy along with protocol-based patient
management of warfarin dosing have led to reduced incidence
of major bleeding in patient monitoring intervention groups.
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 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 non institutionalized
patients begins when the patient perceives a health
care need or health-related problem.
This is experienced as a deviation from what is
“normal” for the individual. It may be the experience of
“symptoms” or other sort of life-style interruption that
challenges or threatens the patient’s sense of well
being.
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 This interpretation is influenced by a host of psychological and social
factors unique to the individual, These include:
1. the individual’s previous experience with the formal health care
system;
2. family influences;
3. cultural differences in the conceptualization of “health” and “illness”;
knowledge of the problem;
4. health beliefs which may or may not coincide with accepted medical
“truths”;
5. psychological characteristics;
6. personal values, motives, and goals.
7. In addition, the patient’s interpretation may be influenced by outside
forces, such as family members who offer their own interpretations
and advice. 19
 The patient at this point may take no action to treat the
condition either because the problem is seen as minor
or transitory or because the patient lacks the means to
initiate treatment.
The quality of the professional assessment depends
on:
1. the thoroughness of the patient report, the
practitioner’s skill in eliciting relevant information,
2. and the receptivity of the professional to “hear”
information from the patient that is potentially
important.
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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. Failure to initiate prescribed
therapy may be caused by economic constraints, a
lack of understanding of the purpose of the
recommendation, or failure to “buy into” the treatment
plan.

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This evaluation results in patients continuing to take the
medications, patients altering their drug treatment regimens, or
patients discontinuing drug therapy.
It is inevitable that, as patients begin drug treatment, they will
“monitor” their own response .
The problem that exists is that patients often lack information
on what to expect from treatment on what to look for that will
give them valid feedback on their response to the medication.
Lacking this information, they apply their own “common
sense” criteria.

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Patients may interrupt the treatment process by
failing to contact you and other providers when
follow-up is expected, which may involve
discontinuing participation in the formal health care
system for a period of time or contacting a new
provider and beginning the whole process again. Of
the patients who do contact their providers, some will
communicate their perceptions, problems, and
decisions regarding treatment. Other patients may
contact providers and not convey this information.
This follow-up contact occurs during revisits with a
physician or refills of prescriptions from pharmacists .
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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 these factors above influence the patient decision to re-
contact providers. These factors also influence the degree to
which medication-taking practices are reported and
perceptions shared.

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 REASONS TO ENCOURAGE PATIENTS TO
SHARE THEIR EXPERIENCE
WITH THERAPY
1. They have unanswered questions
2. They have misunderstandings
3. They experience problems related to therapy
4. They “monitor” their own response to treatment
5. They make their own decisions regarding therapy
6. They may not reveal this information to you unless you
initiate a dialogue

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Analysis of the medication-use process highlights two
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.

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 SUMMARY
In establishing effective relationships with patients,
your responsibility to help patients achieve desired
health outcomes must be kept in mind. The patient
is the focus of the medication-use process. Your
communication skills can facilitate formation of
trusting relationships with patients.
Such a relationship fosters an open exchange of
information and a sense of “partnership” between
you and your patients. An effective communication
process can optimize the chance that patients will
make informed decisions, use medications
appropriately, and ultimately, meet therapeutic goals.
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 REVIEW QUESTIONS

1. What is patient-centered care?

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