Michigan Medicaid recipients' perceptions of medication counseling as required by OBRA '90

Counseling our aging population: A training program for pharmacy students on hearing loss

BACKGROUND AND PURPOSE

Hearing loss affects approximately one-third of adults age 61-70 and >80% of those older than 85 years. This can impede the ability to hear medication administration instructions, leading to poor adherence and unnecessary disease progression and complications. The study purpose was to educate students on hearing loss and identify program impact.

EDUCATIONAL ACTIVITY AND SETTING

An online program for advanced pharmacy practice experience (APPE) students was developed to train students how to counsel patients with hearing loss to improve medication understanding and adherence. The purpose of the training program was to provide background on hearing loss, increase understanding of the impact hearing loss, and to prepare students to counsel this population. A link from SurveyMonkey was provided upon training program completion.

FINDINGS

Ninety-two students completed the survey. Prior to training, < 20% (18.5%) were comfortable interacting with patients with hearing impairment, despite ∼50% of these students completing more than three APPEs with direct patient care. The majority (88%) recognized that hearing loss contributes to poor medication adherence. More than 80% believed that the training program improved their understanding of the psychological consequences of hearing loss and ability to counsel patients with hearing loss. Over 70% agreed that the training program made them feel more prepared to counsel patients with hearing loss.

DISCUSSION AND SUMMARY

It is crucial to prepare students to better understand this population in order to meet their needs. This program enhanced students' knowledge of hearing loss and increased their understanding of communication barriers.

Pharmaceutical Care in the Community Pharmacies of Saudi Arabia: Present Status and Possibilities for Improvement

Pharmaceutical care can be given in all settings: The community, hospitals, long-term care, and the clinic. However, published literature indicates that there is a substantial barrier to implementing pharmaceutical care programs in community pharmacies. This review was conducted to discover gaps and limitations in pharmaceutical care services in community pharmacies in the Kingdom of Saudi Arabia (KSA). We searched PubMed and other available scientific website databases using the following key words to retrieve the relevant articles: Community Pharmacy, Healthcare System, Pharmaceutical Care, KSA. Two authors independently screened the titles and abstracts of promising articles. They discarded irrelevant studies and retained studies, and reviews that held the promise of relevant data or information. The review revealed that only one out of the four studies conducted in KSA retrieved by the authors reported pharmaceutical care service other than dispensing. The same results were reported in other studies conducted in some developing countries. All pharmaceutical care services were reported in studies conducted in Europe. The authors came to the conclusion that in KSA, dispensing of medicines is the dominant service provided by community pharmacists and that there was very limited if not a total absence of other pharmaceutical care services.

Tailored DVDs: a novel strategy for educating racially and ethnically diverse older adults about their medicines

INTRODUCTION

The availability of comprehensive and accurate medication history information in electronic medical records and through electronic prescribing provides the opportunity to create tailored interventions based on individuals' particular medication information needs. To meet the challenges of providing medication information to low-literate English and Spanish speaking older adults, we sought to create individualized, culturally and linguistically inclusive medication education materials for older adults from diverse backgrounds.

METHODS

We used a mixed-method design including a systematic review, analysis of existing data, a telephone survey (n=326), and exploratory focus groups stratified by race/ethnicity and language spoken (11 focus groups; n=106) to identify what information about medications older adults need, want to learn, and in what format. We evaluated reactions to three DVDs at low-income senior community centers (2 focus groups; n=16).

RESULTS

Exploratory focus groups provided insights on areas for improvement in patient-provider communication, and suggested use of vignettes and testimonials. Upon viewing, participants could relate to the testimonials in which actors portrayed people who have problems with their medications and were interested in the medication advice presented, especially when it was presented by a healthcare professional.

DISCUSSION

Tailored medication education materials in English and Spanish DVD and print material format are suitable for low-literate audiences, acceptable to older adults, and feasible to implement using health IT. Virtually all households in the United States have a television, with most having a DVD player. DVD segments can be used in Internet links, physician office-based television, and consumer health IT applications.

Factors predicting poor counselling about prescription medicines in Swedish community pharmacies

OBJECTIVE

To investigate predictors of 'no counselling', 'no questioning' and 'provision of no information' for three prescribed medicines in community pharmacies in Sweden.

METHODS

One hundred pharmacies were randomly selected, stratified by size and location. Three simulated patients visited each with a prescription for fluoxetine, naproxen or metformin. Counselling details and information about the pharmacy and its staff were recorded immediately after the visit. Data were weighted by strata size for analysis.

RESULTS

Data were available for 292 prescriptions. No questioning occurred for 108 (37%), no information for 75 (26%) and no counselling (no questioning and no information) occurred with 53 (18%) prescriptions. Staff ignored negative responses about previous usage and rarely asked further questions or provided information. Predictors of no counselling included when the staff member was over 50 years old (OR=2.10, CI=1.18-3.43), during lunchtime (OR=1.69, CI=1.00-2.86) and when the prescription was for metformin (OR=2.49, CI=1.34-4.63).

CONCLUSION

The findings suggest the importance of therapeutic class and busy times as predictors of no counselling about prescription medicines in Swedish pharmacies.

PRACTICE IMPLICATIONS

Although pharmacy staff should counsel patients, in many cases they did not. Why this happens and what hinders them from doing so needs to be further investigated.

A review of counseling practices on prescription medicines in community pharmacies

BACKGROUND

Counseling has become an integral part of community pharmacy practice. Previous reviews of research into pharmacists' counseling practices on prescription medicines have primarily focused on activities at a national level. None have adopted an international perspective.

OBJECTIVES

To review (1) verbal counseling rates and (2) types of information provided for prescription medicines in community pharmacies and (3) to compare the research methods used in evaluating counseling practice.

METHODS

Published articles in English (1993-2007) were identified based on searches of on-line databases (International Pharmaceutical Abstracts, PubMed, Medline, EMBASE, CINAHL, and Cochrane Database of Systematic Reviews) and cited references in the articles.

RESULTS

Forty research articles met inclusion criteria for studies investigating verbal counseling rates and/or types of information provided for prescription medicines in community pharmacies. The counseling rates reported varied from 8% to 100%, depending on the research methods used. On average, lower counseling rates were found from consumer and observational studies compared with pharmacist- and simulated-patient studies. The type of prescription also influenced the rate. Higher rates were found in counseling consumers with new compared with regular prescriptions. Information on directions for use, dose, medicine name, and indications was more frequently given than information on side effects, precautions, interactions, contraindications, and storage. Most findings came from self-report and observational methods, each of which has limitations. Few studies used triangulation to overcome methodological limitations. In recent studies, simulated-patient methods have been used increasingly to evaluate counseling practice in the natural environment.

CONCLUSIONS

The actual counseling rates are difficult to obtain due to the differences and limitations of each research method. Of all methods, simulated-patient methods appear to be a more reliable method of evaluating counseling practice in pharmacies. In providing information to consumers with prescriptions, pharmacists appear to have fulfilled the minimum legislative requirements or practice standards.

Language barriers to prescriptions for patients with limited English proficiency: a survey of pharmacies

BACKGROUND

Twenty-three million Americans have limited English proficiency. Language barriers can have major adverse consequences in health care, but little is known about whether pharmacies provide adequate care to patients with limited English proficiency.

OBJECTIVES

We sought to evaluate pharmacies' ability to provide non-English-language prescription labels, information packets, and verbal communication, and assess pharmacies' satisfaction with communication with patients who have limited English proficiency.

METHODS

We used a cross-sectional, mixed-methods survey of Milwaukee County, Wisconsin, pharmacies. Survey questions addressed sociodemographic and language-service characteristics of pharmacies. A pharmacist or technician at each pharmacy was asked 45 questions by telephone, fax, or mail. The main outcome measures were the ability of pharmacies to provide non-English-language prescription labels, information packets, and verbal communication; and pharmacy satisfaction with communication with patients who have limited English proficiency.

RESULTS

Of 175 pharmacies, 73% responded. Forty-seven percent of the pharmacies never/only sometimes can print non-English-language prescription labels, 54% never/only sometimes can prepare non-English-language information packets, and 64% never/only sometimes can verbally communicate in non-English languages. Eleven percent use patients' family members/friends to interpret. Only 55% were satisfied with their communication with patients who have limited English proficiency. In multivariate analyses, community pharmacies had significantly lower odds of being able to verbally communicate in non-English languages, whereas pharmacies using telephone interpreting services had significantly higher odds. Pharmacies' suggestions for improving patient communication included continuing education, producing a chain-wide list of resources, hiring bilingual staff, using telephone interpreters, analyzing translation quality/accuracy of labels and information packets, and adding more languages to pharmacy software.

CONCLUSIONS

Approximately half of Milwaukee pharmacies never/only sometimes can provide non-English-language prescription labels or information packets, and approximately two thirds never/only sometimes can verbally communicate in non-English languages. One in 9 pharmacies that verbally communicate in non-English languages use patients' family members/friends to interpret. Almost half of the pharmacies are dissatisfied with their communication with patients who have limited English proficiency. Community pharmacies are less likely and pharmacies using telephone interpreting services are more likely to be able to verbally communicate in non-English languages. Study findings indicate that improvements in pharmacies' communication with patients who have limited English proficiency may result by increasing the quality and number of non-English languages in existing computer programs, hiring bilingual staff, and using telephone interpreting services when in-person interpreters are unavailable.

Conceptualizing and measuring pharmacist-patient communication: a review of published studies

BACKGROUND

Pharmacist-patient communication in community pharmacies has been studied for over 25 years with little effort to evaluate this research comprehensively.

OBJECTIVE

The main objective of this review is to examine and summarize how researchers have conceptualized, defined, and measured pharmacist-patient communication across studies and identify gaps in the literature.

METHODS

Articles were compiled from a search of (1) Medline, IPA, CINAHL, and PubMed databases using the keywords, "counseling", "patient communication", "patient counseling", "patient education", "patient consult( *)", and/or "pharmacists", (2) bibliographies of selected articles. The search generated 56 studies on community pharmacy, of which 39 studies met the inclusion criteria.

RESULTS

Most studies (72%) have used the term patient counseling, although pharmacist-patient communication and patient education were also used. The definition of patient counseling varies across studies. Almost half of the studies (49%) conceptualized pharmacist-patient communication solely as a pharmacist information provision activity. A total of 16 studies (41%) also focused on pharmacists' interpersonal behavior in addition to the information provision activity of the pharmacist. In contrast, patient communication behavior and the exchange process between both parties has been understudied. A total of 16 studies (41%) used a retrospective design. All studies used a cross-sectional design, with varying modes of data collection such as mail surveys, telephone interviews, nonparticipant observation, and shopper studies. Taped encounters are rare. SUMMARY/IMPLICATIONS: This review revealed that most studies have focused on a one way communication of pharmacists to patients. A need for examining the patient-pharmacist dyad is apparent. Future research could explore a greater use of taped encounters to analyze the interactive communication process, affective components of communication such as collaborative problem solving, interpersonal relationship development, and the expertise that patients bring into the encounter.

Quality Assurance Instrument Focusing on Patient Counseling

BACKGROUND

Patient counseling is a professional service provided by community pharmacists. To assess the quality of these services, specific quality assurance instruments are needed.

OBJECTIVE

To develop a validated, easy-to-use patient counseling quality assurance instrument for community pharmacists. The development process was part of a national project to enhance patient counseling in community pharmacies (TIPPA 2000–2003).

METHODS

A modified Delphi method was used with 2 expert panels: Panel 1, consisting of experienced pharmacy practitioners (n = 10), and Panel 2, consisting of academic and professional experts (n = 10). The final consensus was assessed by a Delphi questionnaire round involving both panels, the employers of Panel 1 members (n = 5), and the members of the executive board of the TIPPA project (n = 10), comprising 35 people (response rate 74%; n = 26).

RESULTS

The first Delphi round yielded a high consensus, with the level of agreement varying between 69% and 100%. All but one item met the predefined criteria for approval. A total of 16 indicators were identified in 3 quality dimensions: patient (4 indicators), process (6), and learning and innovations (6). Strategy and vision of the pharmacy in patient counseling formed the core of the instrument.

CONCLUSIONS

The modified Delphi method proved to be applicable in the development process of an instrument assessing patient counseling services. The instrument comprehensively takes into account factors related to quality assurance of counseling practices.

A systematic review of the research on communication between patients and health care professionals about medicines: the consequences for concordance

OBJECTIVES

We draw on a systematic review of research on two-way communication between patients and health practitioners about medicines in order to determine the extent to which concordance is, or is not, being put into practice.

DATA SOURCES

Six electronic databases were searched using the following categories of search terms: health care professionals, patients/consumers, medicine-taking/prescribing and communication. Articles were also identified from handsearches of journals, article reference lists and the Concordance website.

REVIEW METHODS

Studies published between 1991 and 2000 were included. Studies were not excluded on the basis of design, methods or language employed. Abstracts of identified articles were assessed by at least two reviewers and the full articles were assessed by one reviewer and checked by at least one other reviewer. Data on the design, analysis and relevant findings were extracted.

RESULTS

A total of 11 801 abstracts were reviewed and 470 full articles were retrieved. Of the 134 articles subsequently included, 116 were descriptive studies. All but 10 of the papers were written in English. There were mixed findings about the extent to which patients feel that their beliefs, experience and preferences about medicines can be shared. Doctors tend to dominate discussions in consultations, although patient participation is associated with positive outcomes. Health care professionals' behaviour can impede as well as enhance patient involvement.

CONCLUSIONS

There is little research that examines fundamental issues for concordance such as whether an exchange of views takes place. It is possible that interventions are needed to facilitate the development of concordance in practice.

Pharmaceutical care in chain pharmacies: beliefs and attitudes of pharmacists and patients

OBJECTIVE

To discuss with pharmacists and patients with reactive airways disease their beliefs about pharmaceutical care and the pharmacist's role in health care, obstacles to providing pharmaceutical care in community pharmacies, and strategies to overcome these obstacles.

DESIGN

Two focus groups of patients, two focus groups of pharmacists.

PARTICIPANTS

Thirteen patients with reactive airways disease and 11 chain pharmacists.

MAIN OUTCOME MEASURES

Qualitative reports on the pharmacist's role in health care delivery and obstacles to implementing pharmaceutical care programs.

RESULTS

Pharmacists wished to provide pharmaceutical care, and patients were supportive of pharmacists' involvement in their health care. Both viewed counseling as an important role for pharmacists and believed that pharmacists should work with patients' physicians. Reported obstacles included lack of time, inadequate privacy, and pharmacists' lack of direct access to patients' physicians. Pharmacists and patients believed pharmacists should have access to patient-specific clinical data.

CONCLUSION

Focus groups provided valuable information for designing pragmatic pharmaceutical care. The obstacles and possible solutions identified through the discussions represent fertile ground for designing innovative pharmaceutical care programs.

Patients' willingness to pay for pharmaceutical care

OBJECTIVE

To determine the level at which patients receive pharmaceutical care services and their willingness to pay for comprehensive pharmaceutical care services.

DESIGN

A mail survey was sent to 2,500 adults in the United States.

SETTING

Surveys were mailed to subjects' homes.

PATIENTS OR OTHER PARTICIPANTS

Subjects were randomly selected from a marketing database that included representation from each of the 50 states of the United States.

INTERVENTION(S)

The survey provided a description of comprehensive pharmaceutical care, and survey items asked about the level of care subjects were receiving and their willingness to pay for these services.

MAIN OUTCOME MEASURES

Level of various pharmacy services subjects reported receiving, and the dollar amount subjects were willing to pay for comprehensive pharmaceutical care.

RESULTS

The majority of the subjects were not receiving pharmaceutical care services. The average amount all respondents were willing to pay for these services was $13 for a one-time consultation and $28 for this plus 1 year of monitoring. Looking only at those respondents willing to pay (56%), the means rise to $23 and $50, respectively.

CONCLUSION

A majority of patients are willing to pay for pharmaceutical care services, even if they are not now receiving this level of care. Direct payment from patients who recognize the therapeutic benefits of pharmaceutical care may be a more viable option than is generally believed, at least until the profession can prove pharmaceutical care's utility and cost-effectiveness to third party payers.

Interpersonal perception: a theory and method for studying pharmacists' and patients' views of pharmaceutical care

OBJECTIVES

To identify the congruency between pharmacists' and their patients' perceptions of the benefits of services a pharmacist would provide if practicing according to the pharmaceutical care model, and to characterize the relationship between the congruency of their perceptions and the extent to which each reports that such services are provided.

DESIGN

This study employed the interpersonal perception method, a communication theory and tool through which two people's perceptions are compared to assess their agreement with and understanding of one another regarding a particular issue.

SETTING AND PARTICIPANTS

Six independent community pharmacies participated in a written survey of perceptions of pharmaceutical care. Questionnaires were distributed to 100 adult patients from each store. Pharmacists completed a self-report of the pharmaceutical care services provided to their patients; patients were asked whether they received such services.

MAIN OUTCOME MEASURES

Pharmacists' and patients' perceptions of pharmaceutical care; pharmacists' and patients' reports of pharmaceutical care activities.

RESULTS

Pharmacists and patients were found to disagree on the potential benefits of pharmaceutical care services. Pharmacists tended not to understand their patients' perceptions. The differences were not found to be related to the level of pharmaceutical care reportedly provided.

CONCLUSION

The extent to which pharmacists' and patients' perceptions serve as barriers to the provision of pharmaceutical care is yet unknown. This study shows that differences in these perceptions exist and may perpetuate both patients' traditional perceptions of dispensing activities in the community pharmacy and pharmacists' perceptions of lack of patient interest in pharmaceutical care.