Which of the following are potential negative outcomes pharmacists face due to medication counseling?

Transcription

1 "Cash-Register Counseling - Pharmacists Perspectives on Communication Across the Counter: A Study from the Medication Safety Research Network of Indiana (Rx-SafeNet) Jaclyn R. Myers, PharmD, PhD Candidate Kimberly S. Plake, RPh, PhD Anne M. Rodino, PharmD Student Purdue University College of Pharmacy Disclosures Jaclyn R. Myers, Kimberly S. Plake, and Anne M. Rodino declare no conflicts of interest, real or apparent, and no financial interests in any company, product, or service mentioned in this program, including grants, employment, gifts, stock holdings, and honoraria. The American Pharmacists Association is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. Learning Objectives Describe the constructs of the Theory of Motivated Information Management Compare and contrast types of information exchange that occur in community pharmacies Outline processes by which pharmacists make decisions about initiating medication counseling Explain the potential negative and positive outcomes pharmacists perceive as a result of participating in medication counseling Which of the following describes strategies individuals use to seek A. Uncertainty Discrepancy B. Affective Response C. Outcome D. Information Management Systems Which of the following are potential negative outcomes pharmacists face due to medication counseling? A. Poor performance in competing job roles B. Diminished job security C. Negative responses from patients and other coworkers D. All of the above Background Estimates of the verbal communication occurring between pharmacists and patients range between 8-50% (Coleman 2003; Cavaco and Romano 2010; Greenhill et al. 2011; Kimberlin 2006; Svarstad, Bultman, and Mount 2004; Tully, Beckman-Gyllenstrand, and Bernsten 2011). There is no evidence to show that the frequency of counseling has drastically improved since pharmacists were first legally required to offer counseling (De Young 1996)

2 Background Overall, pharmacists provide less than a minute of counseling to less than half of patients that enter their pharmacies (De Young 1996). Some have attributed these low rates of communication to lack of patient demand for information (Puspitasari, Aslani, and Krass 2010). When surveyed, over 90% of patients say they desire medication information from a pharmacist at the time of medication dispensing (Krueger and Hermansen- Kobulnicky 2011). Background Pharmacist factors (i.e. years in practice, job satisfaction, and self-efficacy) Environmental factors (i.e. pharmacy setting) Patient factors (i.e. number of medications, trust in providers) Objectives Use a theoretically-based, qualitative perspective to explore community pharmacists perceptions and decisionmaking regarding: 1) the provision of medication counseling and 2) communication with patients Methods A deductive approach was utilized for development and data analysis. The Theory of Motivated Information Management (TMIM) was the basis of a semi-structured interview guide. Pharmacists within the Medication Safety Research Network of Indiana were invited to participate in telephone interviews. Interviews were transcribed and then independently coded by two research investigators. Investigators then discussed any discrepancies before applying the final set of codes to all interviews. Adapted Theory of Motivated Information Management (Afifi 2004) Uncertainty Discrepancy Affective Response Information Seeker Uncertainty Discrepancy Affective Response Information Provider Outcome Efficacy Outcome Efficacy Information Management Systems Information Management Systems Results Fifteen pharmacist interviews Average length of interview: 46.5 minutes

3 Results: Information Management Systems Results: Decisions About Initiating Medication Counseling Does the patient NEED Is there something about the specific medication that the patient may not know or understand? Is there an imminent safety concern? Based on: Clinical expertise and available patient history Based on: Assumptions about a typical patient and past experiences with patients Results: Uncertainty Discrepancy Does the patient WANT Experiential Perceptions Baseline Perceptions Based on: Assumptions about a typical patient and past experiences with patients Based on: Patient s non-verbal communication and patient s response to: Do you have any questions? Results: Uncertainty Discrepancy the perception people have of it [retail pharmacy] is that it's becoming cheaper, and they see it less as medical service and more of just an errand to check off. Which it is sometimes. But they don't see it as getting medical services like they do a doctor. I mean people are willing to wait at a doctor's office for how long? People are willing to wait at a dentist's office. People are probably even willing to wait for like their flu shot at a pharmacy. But they are not willing to wait for information. They are not willing to wait to get a prescription filled. Because it's not viewed as a medical service anymore. Results: Affective Response Pharmacists described a range of emotions in regards to interaction with patients. Some emotions described included: Fear Sadness Exhaustion Anger Satisfaction Sense of Achievement Sense of Purpose Results: Affective Response you don't want to put yourself out there and then have a negative experience the bad that outweighs the good on a day to day basis can certainly make you hesitant to initiate any contact why would I want to go looking for more?...i'm going to get somebody in my face mad about something. And it can influence your mood it's not like it turns on like turning a light switch on and off it doesn't just go away. You have to get over it, and that can take some time

4 Results: Outcome The most frequently described negative outcomes for pharmacists: Poor performance in competing job roles Diminished job security Negative responses from patients and other co-workers The most frequently described positive outcomes for pharmacists: Increased job satisfaction Increased clinical knowledge Results: Efficacy Pharmacists had strong opinions about how patient perceptions of pharmacists impacted communication. Many pharmacists described scenarios in which they did not believe that patients perceived pharmacists as willing and able to provide counseling. Pharmacists in open environments were more visible to patients, but the pharmacists often believed this visibility was a double-edged sword. Results: Efficacy you know it's "cash-register counseling" and the difference is huge. Think about the other times that we ask patients to talk about their health. It's in the doctor's office, not in the waiting room. Or it's the emergency room, or an urgent care clinic- all those conversations take place in excluded rooms where you don't have to worry about other people listening and there's not a bunch of hustle and bustle going on around you Results: Efficacy And for whatever reason pharmacy 20 years ago decided that this would be a great idea to just turn us into a gas station or a fast food place, and then still try to have respect. Well, yea- talk to us we are professionals. But you know you're standing there with a bunch of crap being sold at the register it's just kind of unseemly for any kind of rational discussion, right?... I think it's a lot easier to treat us like professionals when we are presented like professionals. Discussion This study suggests that pharmacists tend to rely on assumptions to make decisions about communicating with patients in the absence of patient dialogue. Negative past experiences may play a large role in pharmacists willingness to engage with patients. A majority of pharmacists in this study believe that patients do not perceive community pharmacies as clinical environments conducive to medical communication. Key Points The process of pharmacist-patient communication about medications appears to fit the TMIM. Future research may need to explore more complex conceptualizations of medication counseling

5 Which of the following describes strategies individuals use to seek A. Uncertainty Discrepancy B. Affective Response C. Outcome D. Information Management Systems Which of the following are potential negative outcomes pharmacists face due to medication counseling? A. Poor performance in competing job roles B. Diminished job security C. Negative responses from patients and other coworkers D. All of the above 25 26