Pharmacy

Communications
Introduction
•In order to meet their professional responsibilities,
pharmacists have become more patient-centered
in their provision of pharmaceutical care.
•Pharmacists have the potential to contribute even
more to improved patient care 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.
The Pharmacy Care Process
Collect and use

patient information

Follow up to assess Identify patients’ drug patient outcomes

related problems
 Select and recommend Develop solutions
therapies to these problems

Patient Information
Full name
Address and phone
Date of birth (DOB) / age
Gender
Drug list (profile) including all OTC, Rx,
herbal supplements, etc.
Pharmacist comments
Chronic medical conditions (diagnoses)
Keep for 2 years
Prospective DUR
•Over / underutilization
•Therapeutic duplications
•Drug-disease interactions
•Drug-drug interactions
•Incorrect dosage or duration of
treatment
•Drug allergy interactions
•Clinical abuse - misuse
Patient Counseling
Name ( generic )
Intended use and expected action
Route, dosage form, dosage and administration schedule
Special directions for preparation, storage or administration
Precautions to be observed while taking
Common side effects, how to avoid or action required if they
occur
Techniques for self monitoring of drug therapy
Potential interactions or therapeutic contraindications
Refills
What to do if you miss a dose
Any other information THIS patient may need to ensure safe
use

The Communication Model:

•Communication takes two
•sender and receiver
•To optimize communication we must
consider the “channel”
•Two way flow of information
•Potential for a breakdown to occur at any time
•Barriers will exist – minimize these when you
can
Communications Skills in Pharmacy Practice, Tindall, Beardsley and Kimberlin, third ed., 1994, Lea and Febiger,
p 15.
Barriers to communication
Barriers to communication

• Pharmacy Environment
Barriers to communication
Barriers
•Numerous barriers exist that may disrupt or even
eliminate interpersonal interaction.
•Given the large number of potential barriers that
exist in pharmacy practice settings, it is a wonder
that any communication takes place at all.
•Some barriers are rather obvious, while others are
more subtle.
•The key is to identify when barriers exist and then
develop strategies that minimize them.
•This chapter provides an overview of general barrier
issues within communication and provides
examples in a few key areas (practice environment,
personal issues, administrative priorities, and lack of
time and resources).
Environmental Barriers
I. The height of the prescription counter separating patients from
pharmacy personnel.
• These prescription counters exist for three primary reasons:
1. They provide an opportunity for patients to identify where the pharmacy
is located;
2. They provide an opportunity for pharmacy staff to look over the store area
periodically; and
3. They provide a private area in which the staff can work.
• It is difficult for patients to talk with individuals they cannot even see.
• These counters may intimidate some patients and inhibit
communication because the pharmacist is standing over them.
• This environment may also give patients the impression that the
pharmacist does not want to talk to them.
• Counters which are lower to facilitate pharmacist–patient interaction.
• Ideally, you and the patient should both be at eye level to enhance
verbal and nonverbal communication and help counteract patient
perceptions that you are not approachable.
Environmental Barriers
II. Crowded, noisy prescription areas also inhibit one-to-one
communication in many practice settings (Beardsley et al,
1977).
• Many pharmacies tend to have significant background noise,
such as people talking or music playing.
• These noises interfere with your ability to communicate with
patients.
• Privacy is especially important when patients want to talk
about personal matters.
• Some have installed private or semiprivate counseling areas or
rooms.
• Privacy does not necessarily mean having a private room, but
both the patient and pharmacist must feel that privacy exists.
Personal Barriers
•Low self-confidence
•Shyness – more difficult to overcome
•Dysfunctional internal monologue – shifts
attention
•Lack of objectivity
•Cultural differences- definition &perception of
illness, health related habits, health seeking
behaviour & perception of HW
•Discomfort in sensitive situations
•Negative perceptions about the value of patient
interaction
Patient-Related Personal Barrier
•If patients perceive you as not being knowledgeable
or trustworthy, they will tend not to ask questions
or listen to the advice being offered.
•Their belief that the health care system is
impersonal because some patients sense that
health care providers are not concerned about
them as individuals but rather as cases or disease
states.
•Patient perceptions of their medical conditions may
also inhibit communication. Some may believe that
 their condition is a relatively minor one requiring no
further discussion with you.
Administrative Barriers
•Lack of compensation for counselling services
•Design of the pharmacy procedures.
•Staffing policies may also inhibit patient counseling.
•The mechanics of dispensing prescriptions may
distract from the communication process.
•It is difficult to type a label, count medications, talk
on the phone, and complete other necessary
dispensing tasks while trying to communicate with
the patient.
 •Another subtle barrier is the pharmacist’s desire to
answer every phone call, which may give the
impression to the patient that the pharmacist does
not want to talk to him or her.
Basic Counseling and Communication Skills
•Courtesy and rapport:
•Quite possibly the most critical skills you will
need to develop, and includes:
•How to address patients
•Introducing yourself
•Learning patient names
 •Being aware of your appearance, attitude,
issues
•Respecting patient privacy issues
•Avoiding stereotypes
•Using appropriate body language
Body Language
•Message impact:
•7 % verbal
•38 % vocal
•55 % body movements
•Often more believable than words
•Composed of
•Body movements
•Facial expression
•Gestures
•Posture and breathing
•Space
Basic Counseling and Communication Skills

•Body language
•Facial expression – smile
 •Eye contact
•Open posture
•Distance
•Tone of voice
•Get “CLOSER”
•Control distractions, lean in, open
posture, smile, make good eye contact,
relax
Some samples of facial body language….
Bringing it home to pharmacy, is this an example of
good body language for a pharmacist?
Stereotypes
•The process of attributing a set of characteristics to
all members of a group, without regard for
individual differences.
•We all react differently to different kinds of people,
and even differently at different times. Some
reactions are overt, some hidden. They all can
impact how we relate to patients. We want to avoid
letting stereotypes influence how we react to and
interact with our patients.
•Example statements: “Doctors are arrogant”, “You
can’t trust pharmacists”, “Teenagers are
irresponsible”

Hugman, B. Healthcare Communications, Pharmaceutical Press 2009: p50.

A stereotype in action:

I’m not feeling very well – I need a doctor immediately.

Ring the nearest golf course.

Groucho Marx
Stereotypes

•Common and almost everyone holds to some

degree of stereotyping
•What is the impact of this on rapport?
 •Being aware of how you may stereotype
others is critical
•Treat everyone as an individual
Rapport

•A level of mutual consideration and respect

•The “warm fuzzy” part of
communication
•Paves the way for good communication
•Trust is critical
•How do you build trust?
 •How do you keep it?
•What happens when you break it?
Perceptions
FINISHED FILES ARE THE RESULT
OF YEARS OF SCIENTIFIC STUDY
COMBINED WITH THE
EXPERIENCE OF MANY YEARS
OF EXPERTS
 Listening

Basic Skills: Listening Listening Skills:

 Be aware of perceptions Lean forward.
(F test) Actually Listen!
Be non-judgmental Nod your head to show
Be an active listener your attention.
Summarizing, Make eye contact with the
paraphrasing, clarifying, speaker.
feedback (immediate,
honest and supportive)
Use appropriate listening
body language
Use silence where
appropriate
Listening Skills:
Sit up.
Look and act interested.
 Basic Skills: Information
•When communicating important information to
patients, be sure to:
•State the purpose of your communication
•Inquire about what the patient needs
•Use markers for critical information
•“Now, Ms. Smith, this is really important…..I
need you to…”
•Talk in lay terms, but don’t oversimplify
•Avoid technical jargon
•Avoid information overload
•Keep it short and simple, to the point
 Basic Skills: Gathering Information

•When gathering information

•Ask open-ended questions
•Much more information can be gained
•Saves time
•Provides opportunities for patients to reveal
information we might not be thinking about
•“How are you supposed to be taking this…?
•“Tell me more about this…”
Basic Skills: Assessment
The question is, did your patient learn anything
from you? In other words, did the other person
understand what you said, and meant?
To assess:
Summarize your teaching
Verify what your patients know
“Ms. Smith, can you tell me how you will take
your medication?
Reinforce patient understanding when you can
“That’s right, this medication will make you
sleepy…”
Basic Skills: Empathy
•Seek to understand what your patients feel
•Empathy is not sympathy
•Realistically, may not be attainable
because you are not the other person
•Empathy will help you shape your
communication so that others
better understand you!
•Listening and Responding Test
 Basic Skills: Questions
•Encourage patients to ask questions

•“Just let me know if you have any other

questions, OK?

•Key Point: When your patients are comfortable asking

you questions, you know you have rapport and are
doing a good job communicating.
Counseling Methods We Will Learn:
•Basic Counseling
 •Interactive patient counseling
•The Prime Questions
•Counseling in challenging situations
•The PAR technique
•Prepare, assess and respond
•Counseling for compliance
•The RIM technique
•Recognize, identify and manage
KEY PATIENT-CENTERED CARE
• Pharmacist requires to switch from a “medication-centered”
or “task-centered” practice to patient-centered care.
• Pharmacists must participate in activities that enhance
patient adherence and the wise use of medication (i.e., focus
on patient centered elements including patient
understanding and actual medication taking behaviors).
• 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
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.
Mead and Bower (2000): 5 dimensions of PCC:
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.
The ideal relationship is more egalitarian than is
traditionally seen, with patients more actively
involved in dialogue and in the decision-making
surrounding treatment.
Mead and Bower (2000): 5 dimensions of
PCC:
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.
Patient perceptions that you “care” for them (as well as
providing care) are essential to the establishment of trust.
Examination of reasons for filing malpractice claims
against providers suggest that patient anger over a
perceived lack of “caring” from providers and
dissatisfaction with provider communication were
 important elements in decisions to file (Hickson et al,
1992).
5. Providers must be aware of their own responses to
patients and the sometimes unintended effects their
behaviors may have on patients.
Interprofessional Communication:
Introduction
• Communication among health professionals and organizations is a
highly complex and is an important function in the provision of safe
healthcare and promote professionalism and self-identity.
• Ineffective communication is reported as a significant contributing
factor in healthcare errors and inadvertent patient harm.
• Effective communication requires the use of many skills.
• Effective interprofessional communication is communication that
occurs in an open, collaborative and responsible manner.
• It is communication that is built on mutual trust among healthcare
professionals/providers/learners, patients and their families.
• As stated earlier, each health discipline brings knowledge to the
conversation.
• Some of the knowledge is overlapping, but much of it is not.
Pharmacist Roles in Collaborative Medication
Therapy Management
• The traditional process of prescribing a drug, dispensing a
drug, administering a drug, monitoring a drug regimen, and
adjusting drug therapy can be very disjointed—a process
that is well documented for its ability to produce avoidable
drug-related problems.
• Documentation has shown that these problems contribute
to poor health outcomes and significant increases in the
cost of health care (Webb, 1995).
• These expanding roles are changing public perception of
pharmacists as being among the most reliable, trusted, and
accessible health care providers (Tindall and Millonig,
2003).
• Pharmacists are more active in chronic disease programs
for asthma, diabetes, hypertension, smoking cessation,
osteoporosis screening, and influenza immunizations.
Pharmacist Roles in Collaborative Medication
Therapy Management
•Pharmacists assume new responsibilities that
extend beyond ensuring accuracy and
 appropriateness in the processing of
pharmaceutical orders– ”promotion of good
therapeutic outcomes for patients.”
•Pharmacists are held accountable for the
provision of appropriate patient care related to
management of medication therapy.
•Many pharmacists are realizing that they must
work more closely with physicians and other
health care providers in order to facilitate this
process.
EVIDENCE BASED OUTCOMES OF COLLABORATION
1. Pharmacists working in collaboration approach to medication use
can prevent errors and reduce drug costs (Isetts et al, 2003).
2. When faced with the reality that patient health issues are typically
too complex for one health professional to handle, the need for
interdisciplinary expertise becomes obvious (Fredrick, 2003).
3. Patient adherence with medications significantly improves when
pharmacists and physicians collaborate (Fredrick, 2003).
4. Confrontational relationships and procedural obstacles can be
replaced with collaborative and trusting relationships when both
physicians and pharmacists work on reducing feelings of
discomfort about each other’s skills, roles, and authority (Fredrick,
2003).
5. Develop the best outcomes for patients by reducing medication
errors, increasing patient safety, and reducing health care costs
associated with such errors.
6. Improve a patient’s quality of life through well-established and
successful initiatives (Mass. Fact Sheet, 2005).
4 key Characteristics of effective
Collaboration
1. Sharing: includes sharing of responsibilities, philosophies of
health care, values, planning, interventions, and
perspectives such as commitment to patient-centered care.
2. Partnering: implies that two or more people will join
together in a collegial, authentic, and productive
relationship characterized by honest communication,
mutual trust, and respect. In addition, partners value the
work and perspectives of the other professionals in the
partnerships, and each works toward common goals having
specific outcomes.
3. Interdependency: refers to the fact that professionals are
interdependent, rather than autonomous, as they work
toward meeting patient needs.
 4. Power: is seen as being shared among partners with
empowerment accorded to all participants. Sharing of
power is based on knowledge and experience rather than
functions or titles (University of Toronto, 2004).
Barriers and Facilitators to Collaborative
Partnerships
1. Attitudes of some providers that giving
pharmacists a greater role in drug therapy
decision-making encroaches upon the provider’s
broad patient care powers and erodes some of
their autonomy.
2. Lack of clear definitions for these collaborations so
that effective communications among stakeholders
can occur.
3. Lack of a supportive culture at the public,
institutional, professional, and agency levels so
that broad support can be gleaned among
colleagues.
4. Lack of a supportive regulatory and statutory
system so that clear articulation of professional
responsibilities can occur.
Barriers and Facilitators to Collaborative
Partnerships
5. Lack of economic incentives to reward
collaborating professionals who see the
benefits of collaboration to outstrip any
investment in its costs,
 6. Lack of educational programs that encourage
health professionals to work collaboratively,
7. Lack of understanding by patients about the
benefit of collaborative care, which leads to
decreased demand for collaborative care, and
8. Lack of communication technology to allow
partners to easily communicate with each
other.
Development of Model Collaboration
1. Share a common understanding of the context of their
collaboration
2. Identify the various collaboration partners
3. Develop mechanisms to govern themselves
4. Develop mechanisms to handle shared revenues and
expenses
5. Advocate for any needed legislation or professional standards
that would strengthen their partnership and also stimulate
other partnerships
6. Develop guidelines for partner relationships
7. Clearly define their target community
8. Determine how varying professional cultural issues are
handled
9. Establish criteria for when the collaboration may be dissolved
in the future
Targets for Collaboration
•Health care practitioners who have an interest in the
proposed partnership
•Patients or patient groups (broad-based and
influential) who may benefit from your partnership
•Individuals willing to share time and resources to
make your collaboration work
•Solicited the support of community agencies and
media interests who would like to see your
collaboration be successful and contribute to your
community
•Assembled examples of other collaborative
relationships that have worked with descriptions
of their structure and governance
Building Trusting Relationships
•Trust between physicians and pharmacists
cannot be decreed or legislated.
•The willingness to trust is based on a
combination of shared values, attitudes, and
interests.
•Trust is built by the confidence one has in
another person’s predictable behavior or the
security that one has in a person’s
representations (Lewis and Weigert, 1985).
•Functional trust emerges when there is
considerable interdependence, and thus, some
 degree of power sharing between physicians
and pharmacists (Lewis and Weigert, 1985).
Essential Perception in Trust development
• Does this person share in my goals?
• Does thisindividual recognize that we are creating
opportunities for change as like-minded individuals to tackle
an issue important to our patients?
• Does this person have the required knowledge and ability to
help us reach our goals?
• Will this person stick to his or her commitments and be
reliable?
• Will this person share with me information that I need to
know?
• Does this person want me to be successful as a partner in this
intervention?
• Is what we are doing creating real value that will be of service
to patients?
Essential Perception….. (Continued)
•Trust will grow between collaborators when both
perceive a high degree of predictability of one
another’s behaviour.
•Trust occurs when individuals perceive that the
other party will not engage in opportunistic
behaviour that exploits the vulnerabilities of
another or exploits a position of power (Guilati,
1995).
•Good collaborations always provide freedom to
represent their interests and participate in a fair
and open dialogue, unfettered by coercion,
manipulation, secrecy, concealment, or deception
(Habermas, 1984).
Enhancing communication within a trusting
relationship
Some possible indicators include the fact that
colleagues:
•Have demonstrated they can maintain
confidentiality
•Are visible and accessible to each other
•Are consistent in their behaviours
•Are consistent in their commitments
•Share personal information about nonwork
lives (such as hobbies)
Continued
•Express a personal interest in the other person

•Are non-judgmental of one another within the

partnership

•Use effective listening when interacting with others

•Admit mistakes and what they learned from them

•Develop their own personal knowledge and skills on

an on-going basis (Costa and Garmston, 1994)
Six Critical Behaviours Within Collaborative
Partnerships
1. Relationships have long-term and shortterm
agendas
2. Relationships are nonhierarchical and based
on equality
3. Considering patient perspectives
4. Trust and shared visions are central to these
relationships
5. Relationships should demonstrate respect
for the culture of each professional
6. Collaborative relationships should be
voluntary
The End