Studying communication between community pharmacists and their customers

Management of uncomplicated gastric ulcer in community pharmacy: a pseudo-patient study

Background Increasing role of community pharmacists sometimes demands the diagnoses of minor ailments using appropriate questioning skills and recommendation of over-the-counter medications to patients seeking self-care. Objective To evaluate community pharmacists' questioning and diagnostic skills of minor ailment complaints, and the appropriateness of medication(s) recommendations made. Setting One hundred and thirty-one community pharmacies in Ibadan, Nigeria. Method A cross-sectional survey employing pseudo-patient study method. The pseudo-patient visited 131 community pharmacies from June 2017 to January 2018 and complained of stomach ache. The conversation between the pharmacists and pseudo-patient were audio-taped and transcribed verbatim. Two criteria were used to evaluate the questioning skill of the community pharmacists. One of the criteria was developed by a six-membered panel and had 13 questions while the other contained five questions:-Who is it for? What are the symptoms? How long have the symptoms been present? Action taken? and Medication used.? Questioning skill of the community pharmacists was classified based on the median scores of these two criteria as: poor, moderate and optimal. The diagnoses made by the community pharmacists from the pseudo-patients complaints were compared with the expected diagnosis of uncomplicated gastric ulcer caused by the use of ibuprofen. Recommendations for the pseudo-patients minor ailment were also compared with the Nigeria standard treatment guideline. Main outcome measure Pharmacists' questioning skill, types of diagnosis made and appropriateness of medications recommended. Results The median scores for the questioning skill criterion containing 5 and 13 questions were 2 and 4, respectively; showing poor questioning skill. Differential diagnoses of gastric ulcer, dyspepsia, gastroesophageal reflux, and hyperacidity were made by 92 (67.4%) pharmacists but 3 (2.3%) correctly diagnosed the pseudo-patients' minor ailment as uncomplicated gastric ulcer caused by short-term use of ibuprofen. Antacids were recommended in line with the standard treatment guideline by 46 (35.7%) pharmacists while proton pump inhibitors were recommended by 6 (4.7%) pharmacists. None advised the withdrawal of the provocative factor according to the treatment guideline. Conclusion The questioning skill of the community pharmacists in this setting was poor. Few community pharmacists diagnosed the pseudo-patients' minor ailment correctly. Also, recommendations were mostly inappropriate compared with the standard treatment guideline.

Developing community pharmacy services wanted by local people: information and advice about prescription medicines

An extended information service on prescription medicines was evaluated in four community pharmacies over a period of 11 months, including a three-month pilot phase. Written patient information leaflets (PILs) and structured verbal advice designed according to the preferences of local people were provided by the pharmacist to patients prescribed any of three study drugs — amoxycillin, atenolol or ibuprofen. A total of 1,614 PILs were issued. Data were collected from a sample of 311 recipients about their perception and recall of the information service. Altogether, 64 per cent remembered receiving the study leaflet and 56 per cent remembered receiving some verbal information from the pharmacist. More than 80 per cent of service recipients supported the provision of both verbal and written information by the pharmacist. In the main study period (n=203), the types of information respondents could recall receiving most frequently were when to take the medicine (67 per cent), the name of the medicine (53 per cent) and side effects (41 per cent). Sixty seven per cent (40) of those receiving amoxycillin, 61 per cent (43) taking atenolol and 38 per cent (28) taking ibuprofen recognised a side effect of their medicine given in both the leaflet and verbal advice. For all three drugs, side effects were recognised most frequently when included in both the written and verbal information. Support for this aspect of the pharmacist's extended role has been demonstrated in practice and the feasibility of service implementation is discussed.

Customers' recall of information given in community pharmacies

Three studies are reported in which the giving of information to customers, orally, in community pharmacies was tape recorded, and the customers were interviewed the following day. Customers' recall of information, including instructions considered to be essential, was low. In study 1, involving 44 customers in two pharmacies, a mean of 11 items of information was given to customers, but on average only three were recalled. Customers who took a more active part in discussion with the pharmacist (who were more likely to purchase self-medication than to be prescription customers) tended to be given more new information and more repeated information, to recall more but also to forget more than passive customers. In study 2, 42 customers of three pharmacists were interviewed to determine the influence of a number of variables on recall. Whether customers reported feeling ill or in a hurry, or reported having received the information already from their general practitioner, or having had prior experience of the medication, were all unrelated to the amount of information recalled. The few customers who reported that the information provided by the pharmacist was not welcome were particularly poor at recalling it. In Study 3, the amount of information given or recalled was found to be unaffected by whether customers talked to a pharmacist in the busy sales area (n=25) or in a quiet counselling area (n=27). If pharmacists are to be effective providers of information about health and illness, attention must be paid to ways of improving customers' retention of information given.

Verbal interactions between elderly people and community pharmacists about prescription medicines

Tape recordings of verbal interactions between elderly patients (women aged 60 or over; men aged 65 or over) and community pharmacists about prescription medicines were made in four study pharmacies to determine the frequency with which information was provided and to elucidate communication issues relevant to this patient group. Overall, 65 per cent of elderly patients receiving prescribed medications had no verbal interaction at all with the pharmacist, speaking only to other pharmacy staff. The pharmacists provided verbal information to 12.5 per cent of elderly patients about their prescription medicines. It was generally limited to aspects of the dosage regimen and the most common number of items of information given was three. There was no obvious pattern in advice giving related to the estimated workload. However, the frequencies with which advice was provided at all the pharmacies were too low to draw definite conclusions. The mean length of interactions where information was provided was 71 seconds (range 8 to 335).

During 43 interactions studied, pharmacists asked 38 questions, nearly all of which were closed; patients asked 15 questions of which more than a third were open. As expected, the number of elderly patients visiting the pharmacies and the number of patient interactions showed marked intra- and inter-pharmacy variation. This is relevant to the development of realistic advice-giving protocols.

Patient counselling: an investigation of core situations and difficulties in pharmacy practice

Within the past five years there has been a growth of interest in the application of communication skills training (CST) programmes to pharmacy. The content of these programmes has been based primarily on research carried out in other health professions. There is a clear need for similar research to be set in the context of pharmacy so that the content of CST programmes can be shown to be directly relevant and applicable to practice needs. The purpose of this investigation was to ascertain from pharmacists their perceptions of the range of situations and difficulties that were most relevant to patient counselling. The situation which was regarded as being most prevalent was that of dealing with confusion over medication, with the second being that of medication problems in the elderly. The two most frequently mentioned counselling difficulties were having sufficient time to deal with patients and ensuring patient understanding. The findings are discussed within the context of the design and content of CST programmes, and the wider application of the behavioural and social sciences to the practice of pharmacy.

Public views on an extended role for community pharmacy

The acceptability to the general public of an extended role for community pharmacy was investigated using a social survey methodology. Within one locality, a sample of 133 respondents was drawn from four population groups who were likely to be extensive users of community pharmacy services: active elderly people, mothers of young children, carers of people with disabilities and people in full-time employment. The evidence from the interview survey was supplemented by discussions with community groups representative of the same sections of the population. The results indicate that there is considerable public support for the development of a range of new services in community pharmacies, with a majority of respondents supporting the provision of more information on prescribed medicines, opportunity to discuss minor symptoms with the pharmacist, medicine delivery services, and the holding of patient medication records. There is less support for discussing health promotion with the pharmacist, while cost was found to be a major obstacle to the acceptability of diagnostic testing. Elderly people found all aspects of the extended role less acceptable than did other respondent groups. It is concluded that there is a need to market unfamiliar services, and, if an extended role is to be developed effectively, the nature of the relationship between the roles of the community pharmacist and the GP needs to be demonstrated more clearly to service users.

Evaluation of Community Pharmacists' Recommendations to Standardized Patient Scenarios

BACKGROUND:

Recent trends in the global nonprescription drug market show a massive increase in medicine availability to the general public. This places greater responsibility on community pharmacists to ensure that patients exercise self-care appropriately. This small study examined pharmacist performance in facilitating patient self-care.

OBJECTIVE:

To determine whether an appropriate course of action was taken by UK community pharmacists practicing in one geographic area when presented with 1 of 2 case scenarios: headache or abdominal pain.

METHODS:

A covert researcher, posing as a patient, spoke with the pharmacist on duty at each of 30 pharmacies, asking for advice on one of the scenarios. The pharmacist was interviewed and their responses were examined by an expert panel.

RESULTS:

Thirty pharmacies were visited resulting in 28 consultations, 14 each for both scenarios. Pharmacists performed better when counseling the “patient” with abdominal pain than headache. The majority of questions asked were categorized as being relevant by the panel (66% for headache, 89% for abdominal pain), although in both scenarios, the expected outcome of referral was observed only in 7 of the consultations for headache and in 8 cases for abdominal pain. Questioning centered on quantification and clarification of the presenting problem and rarely on questions related to history taking.

CONCLUSIONS:

Performance levels of the community pharmacists varied considerably. For all pharmacists to perform well, greater emphasis should be placed on eliciting information from the patient to ensure that the appropriate course of action is taken.

Expanding the roles of outpatient pharmacists: effects on health services utilisation, costs, and patient outcomes

BACKGROUND

In recent years pharmacists' roles have expanded from simply packaging and dispensing medications to working with other health care professionals and the public.

OBJECTIVES

To assess the effects of expanding outpatient pharmacists' roles on health services utilisation, the costs of health services, and patient outcomes.

SEARCH STRATEGY

We searched the Cochrane Effective Practice and Organisation of Care Group specialised register, MEDLINE, EMBASE, Pharmline, International Pharmaceutical Abstracts and reference lists of articles up to December 1995. We also searched the published abstracts of three meetings and hand searched five journals and two bibliographies.

SELECTION CRITERIA

Randomised trials, controlled clinical trials, controlled before-and-after studies and interrupted time series analyses of interventions comparing 1. Pharmacist services targeted at patients versus services delivered by other health professionals; 2. Pharmacist services targeted at patients versus no intervention; 3. Pharmacist services targeted at health professionals versus services delivered by other health professionals; and 4. Pharmacist services targeted at health professionals versus no intervention.

DATA COLLECTION AND ANALYSIS

Two reviewers independently extracted data and assessed study quality.

MAIN RESULTS

Fourteen studies were included involving more than 1991 patients. In the one study identified for comparison 1 the relative changes in professional outcome measures ranged from a 24% increase in clinic visits to a 16% decrease in hospital admissions. Relative differences in patient outcome measures were not statistically significant. Seven studies were identified for comparison 2. Four measured process of care and demonstrated decreases in health services utilisation from -67% for hospital admissions to -564% for total ambulatory care visits, as well as decreases in the numbers and costs of drugs compared to control patients. Five measured patient outcomes and consistently reported improvements in the targeted patient condition. In the one study identified for comparison 3 the intervention delivered by the pharmacist was less successful than that delivered by physician counsellors in decreasing inappropriate antibiotic prescribing. All six studies identified for comparison 4 demonstrated that the pharmacist intervention produced the intended effect on physician prescribing practices. These studies did not measure patient outcomes.

REVIEWER'S CONCLUSIONS

The limited number of studies analysed support the expanded roles of pharmacists in patient counselling and physician education. However, doubts about the generalisability of the studies, the poorly defined nature of the interventions tested, and the lack of studies including cost assessments and patient outcome data indicate that more rigorous research is needed to document the effects of outpatient pharmacist interventions.

Pharmacists' evaluation of key communication skills in practice

This paper reports the results of a major research initiative into the identification of key communication skills in community pharmacist-patient consultations. It is now widely accepted that the quality of practitioner-patient communication is fundamental to effective health care. However, an analysis of the literature pertaining to the communication issues facing health professionals in general and pharmacists in particular emphasised the need for more empirical research, to chart what pharmacists themselves deemed to be the nature and range of skills which contribute to effective communication performance in community pharmacy practice. The main aim of this research investigation was, therefore, to identify what constituted effective communicative performance by community pharmacists. This paper provides full details of the repertoire of skills and sub-skills identified as being the core communicative elements of practice. The results of this research will have relevance for health professionals and behavioural scientists, and will also contribute to the assurance of quality within the field of community pharmacy practice.

Assessing the effectiveness of communication in organisations: the communication audit approach

Within the past decade there has been an enormous growth of interest in the field of organisational communication. Numerous books, book chapters and journal articles have been devoted to this topic. However, much of this output has been at the level of common sense exhortation, has tended to be anecdotal, or at best has been based upon the personal experience of the authors. Certainly within the UK there has been little hard empirical research into the nature, flow and functions of communication within organisations. This paper proposes the introduction of a much more systematic methodology for the study of such communication, based upon what is known as the 'communication audit' approach. This approach is fully explained and the main methods employed in communication audits outlined, together with their relative advantages and disadvantages. It is also pointed out that audits are now widely employed to measure performance in other spheres of the organisation, such as finance, and it is argued that the implementation of this system to measure communication performance is therefore long overdue. The benefits for organisations of carrying out audits are highlighted and suggestions are made about possible future directions for research in this area.