Evaluation and Improvement of Communication with the Patient in the Community Pharmacy
Cezara M. Maxim1 , Eugenia Bratu2
1 B.Pharmacist, Researcher in Social and Medical Services and Public Health Management
2 Lecturer, Carol Davila University of Medicine and Pharmacy,
Bucharest-Romania-Europe
ABSTRACT: This research work aimed to assess the communication relationship between the pharmacist and the patients who are addressing in the community pharmacy. The hypothesis from which we started the research was the identification of those reasons that determine efficient communication within a community pharmacy, both from patients perspective and from specialized pharmacy staff (pharmacists and pharmacy assistants views being analyzed only qualitatively, not quantitatively). The instrument used for the study was a questionnaire with a total of 26 questions.
The first objective of the research was to identify the level of trust in the pharmacist's advice.
There was a high level of confidence towards pharmacists and pharmacy assistant shown by the subjects enrolled in the trial, which demonstrated the importance of effective communication between specialists in pharmacy and patient/client – this beeing the first reason stated by respondents for having confidence in pharmaceutical counceling. Also, this could be used as a marketing strategy in patients/clients loyalty.
The second objective of the study was to identify which are the optimal means for increasing patient’s loyalty in the pharmacy.
Analyzing the loyalty’s impact after introducing a customer loyalty card and the percentage of requests for introducing such card, it was found to be a very good patients / clients loyalty method. It can also be a way of monitoring certain drugs and pharmaceutical products consumption that address the population in pharmacy according to certain criteria (age, gender, monthly income, education level, disease etc).
The third objective was to identify patients’ views on how communication is done between the pharmacy specialized staff and patient/client.
It proved that a close connection between the drive time and the information provided in plain language to explain is needed due to the fact that each patient/client needs a certain time according to their personal needs at the time. A significant part of the subjects from pharmacy does not purchase products for personal use, beeing only caretakers.
Also, the expectations someone has from the pharmacy staff are as follows, in order of importance as were analyzed in the study: patient/client to first understand first what is being explained to him/ her and to be listened and understood by the specialist. At the same time, communication must be done on an appropriate tone, hence, the patient/client will feel respected and appropriatley treated, and ultimately leave the pharmaceutical unit with a good feeling.
Another objective was to identify the views of pharmacists and pharmacy assistants regarding the communication with the patient/client. In this study we pointed how specialists had the wrongful idea of the possibilities that would motivate customers to return to the pharmacy and the willingness to become loyal to the pharmaceutical unit through a loyalty card.
The following objectives for a future effective communication between pharmacy staff is to follow a course in effective communication with the patient/client; to introduce a loyalty card; to create a database of the most commonly purchased products, according to a specific disease, and to develop informative articles, booklets that are provided to patients/clients.
Table of contents
INTRODUCTION…...... 5
Chapter 1. The relationship between the pharmacist, the population addressing the pharmacy and the type of pharmaceutical unit………………………………………………………………………7
1.1.The pharmacist……………………………………………………………………….7
1.2.The pharmacy………………………………………………………………………...9
1.3.The population addressing to the pharmacist………………………………………10
1.4.The relationship between the pharmacist and the population addressing to the pharmacist……………………………………………………………………………..10
Chapter 2. The types of pharmacist and patient/customer in terms of the way the communication is established…………………………………………………………………………………………… 12
2.1. The concept of efficient pharmacist……………………………………………………….. 12
2.2. The population addressing to the pharmacist……………………………………………...12
2.2.1. The patient/customer according to dominance and sociability criteria………………...13
2.2.2. The patient/customer with a rigid relational pattern, without communication skills…..13
2.2.3. The patient with educational demands and special needs……………………………...15
Chapter 3. Ethics and deontology of communicating with the population addressing the pharmacist ……………………………………………………………………………………………………….. 16
3.1. The pharmacist’s deontological code and its application with the population addressing the pharmacy…………………………………………………………………………………………… 16
3.2. Rules of good pharmaceutical practice (GMP) and communication with the population addressing the pharmacy……………………………………………………………………………. 18
Chapter 4. Communicating with the population addressing the pharmacy……………………...20
4.1. Communication techniques in the pharmacy……………………………………………...20
4.1.1. Opening the discussion…………………………………………………………………20
4.1.2. Investigating the patient……………………………………………………………...... 20
4.1.3. Conveying information………………………………………………………………...21
4.1.4. Ending the discussion………………………………………………………………….22
4.2. Nonverbal communication…………………………………………………………………23
4.3. Barriers to communication in the pharmacy……………………………………………..23
4.3.1. Barriers related to the environment…………………………………………………..23
4.3.2. Barriers related to the patient…………………………………………………………24
4.3.3. Barriers related to the pharmacist…………………………………………………….24
4.3.4. Other communication barriers………………………………………………………..25
4.4. Other ways of communicating with the patient………………………………………….25
4.4.1.Communicating on the phone ………………………………………………………..25
4.4.2. Communicating over the internet……………………………………………………26
Chapter 5. Goals and objectives of the paper………………………………………………...... 27
Chapter 6. The Research Methodology..…………………………………………………………28
6.1. The type of study and the method used in research…………………………………….28
6.2. Target population…………………………………………………………………………28
6.3. The Instrument……………………………………………………………………………29
6.4. The research calendar…………………………………………………………………….30
6.5. Gathering and processing the data……………………………………………………….30
Chapter 7. The research results……………………………………………………………………31
Conclusions and suggestions on improving communication between the specialized personnel in the pharmacy and the population addressing a community pharmacy……………………………..50
Bibliography…………………………………………………………………………………...…….54
Annex 1…………………………………………………………………………………………...... 56
INTRODUCTION
The communication between the population addressing the pharmacy and the specialized personnel offering health services in a pharmaceutical unit is a very debated subject in our time, raising real problems in practical everyday situations.
Being a pharmacist, I have often encountered difficulties in efficiently communicating with the population addressing the pharmacy. This is due, on one hand, to the type of patient/customer that can adopt a rigid way of relating, making the communication difficult (the dominant, obstructive, avoiding or addicted patient) or he can be emotional, sometimes authoritarian or reflective. These tense situations can almost always be avoided if the pharmacist can recognize the patient/customer typology and adapts the communication to the his needs and personality.
The population addressing the pharmacy has individual and complex characteristics, the patients coming in can have their own needs or they are caregivers of other patients. They have different ages (they can be children, adults or elders), come from a certain social category, have different trainings and education, with various types of activity, ethnicity, and sometimes they are people with special needs.
The contemporary pharmacist is, by his professional formation, the recognized specialist in the field of drugs, his entire activity being oriented towards the patient’s needs. Thus, besides the classic and traditional attributions, the pharmacist is increasingly involved in patient health care activities, being responsible of giving information about the product and making sure that it’s used correctly; furthermore, the pharmacist has an important role in making the patient accept and apply the treatment.
I chose this topic because in the last year I have attended several conferences and professional meetings that approached the concept of pharmaceutical care, which in Romania is still in an early stage of development. Pharmaceutical care is essentially the practice in which the pharmacist assumes responsibility for the patient’s needs regarding a drug, in order to achieve results that increase the quality of the patient’s life. It is easy to see that the instrument with which the concept of pharmaceutical care can be achieved at an European standard starts from establishing an efficient communication between the transmitter and receiver, respectively the pharmacist and the patient/customer.
Therefore, I decided to turn to account my knowledge from the field of pharmacy and to assess the communication relationship between a pharmacist and the population addressing an independent community pharmacy by analyzing the communication situation starting with the pharmaceutical unit where I perform my activity, considering the fact that I can analyze the data from multiple angles.
Nowadays, the community pharmacy has lost its appearance from past ages, always being in step with technology, a great influence in this respect being the chains of community pharmacies who have entered the market with a high standard, a well developed system of marketing and management, and with ways of customer retention like loyalty cards. This is why I wish to find out the patients’/customers’ opinion about the best ways of customer retention and what can make them have more confidence in the advice given by the specialized personnel in the pharmacy.
This research paper captures theoretical and practical aspects of the process of establishing an efficient communication relationship between the specialized pharmacy personnel and the population addressing the pharmaceutical unit, identifying the main strengths and obstacles that may rise in implementing the proposed changes for this level.
Chapter 1
The Relationship between the Pharmacist, the Population Addressing the Pharmacy and the Type of Pharmaceutical Unit
1.1The Pharmacist
The pharmacist is a licensed health professional, providing specialized health services to the patient and the general public. By the services provided to the whole community, the pharmacist prescribes medication, prepares it and offers counseling.
The role of the pharmacist in pharmaceutical care involves developing a relationship with the patient or with his caregiver, collecting the patient’s information and evaluating its relevance, assessing the patient’s health, identifying the patient’s expectations regarding the therapeutic result. The pharmacist also has pharmacotherapeutical knowledge necessary to identify current and potential problems related to a drug.
The pharmacist’s responsabilities:
A)Establishing a relationship with the patient or his caregiver:
-establishes and maintains a relationship with the patient by using efficient communication skills in order to initiate dialogue by: listening, verbal and written skills; receptiveness to nonverbal communication; receptiveness to fluency issues of the spoken language (Romanian, English, Hungarian etc.); receptiveness to population diversity (various ethnic groups);
-shows care, empathy and professional conduct;
-identifies the patient’s needs, values and desired therapy results;
-assesses the impact factors and impediments for the health of each patient;
-discusses with the patient about the responsibilities of the parties (pharmacist-patient), highlighting the benefits of accepting them and the consequences in case they are not.
B)Collects and evaluates the relevance of patient information:
-develops professional relationships with other health professionals involved in the patient’s health
-identifies the patient’s needs, the desired level of healthcare and results;
-actively listens and interprets the given information.
C)Assesses the patient’s health status:
-uses techniques and specific procedures to assess the patient’s health status and concerns;
-uses basic knowledge in order to understand the scope and the extent of the patient’s health problems;
-identifies the factors that impact the therapeutic result.
D)Identifies the patient’s expectations regarding the therapeutic result:
-integrates knowledge about the patient’s health status with pharmacotherapeutic knowledge and non-drug treatment options;
-allows the patient to choose from several therapeutic options.
E)Possesses a level of pharmacotherapeutic knowledge required to identify current and potential medication issues:
-determines if the patient requires drug therapy, if drug therapy is required but not received, or if it’s received in a wrong way;
-determines if the medication dose is correct and if it’s properly administered;
-recognizes the drug interaction;
-recognizes side effects, toxic effects of medication;
-explains indications, contraindications and issues that can appear during the treatment.
F) Assesses, selects and recommends appropriate treatment options, non medicinal, OTC drugs (without prescription), drugs with prescription (doctor’s advice):
-prioritizes emergencies;
-assesses alternative strategies of therapy;
-selects the best therapeutic option for the patient, agreeing with the patient and with other healthcare professionals;
-explains the patient the motivation for the proposed treatment.
G)Refers patients to other specialists when necessary:
-determines if a specialist’s opinion is necessary;
-identifies the most appropriate specialist (or team of specialists) for patient guidance.
H)Develops and implements plans to monitor the patient’s progress and to evaluate the therapeutic result:
-recognizes the important clinical indicators (signs and symptoms of the patient);
-identifies the most appropriate ways of monitoring;
-establishes effective plans that include onset, frequency and duration of monitoring;
-encourages the patient’s involvement in implementing and developing the therapeutic plan;
-discusses with the patient or caregivers about the responsibilities of the pharmacist, patient and other professionals involved in the treatment plan.[1]
1.2The Pharmacy
The pharmacy is the health unit that prepares and releases medication to the population and medical units in order to prevent and cure diseases, which makes a vital contribution in maintaining and improving the health of the population.
Pharmacies are institutions that are part of the health care system in which pharmacists operate, in which specialized activities are carried out by highly skilled indiviaduals.
Under the current legislation, the community pharmacy provides pharmaceutical care to the population by:
-releasing medication given on prescription at a retail price;
-releasing, in accordance with the legal provisions, medication without prescription at a retail price;
-preparing magistral and officinal drugs or other healthcare products;
-controlling and assuring the quality of drugs prepared in the pharmacy;
-chemical quality control of pharmaceutical substances that enter the pharmacy, except toxic substances and stupefacients;
-sale of cosmetics, parapharmaceutical products, medical devices for individual use and supplies for them, food supplements, anodyne plants and products based on anodyne plants, products for infant care, items for personal hygiene, equipment, materials or products for protecting or improving health, products for protection against sexually transmitted diseases or with contraception action, homeopathic products, products for aromatherapy and other products intended for use in several pathologies;
-informing and advising patients regarding the proper and rational use of medication and maintaining the health status;
-testing biological parameters with equipment destined for individual use, as well as the administration of vaccines, under the conditions set by the Minister of Public Health.[2]
1.3The Population Addressing the Pharmacy
According to the Law of the Patient’s Rights, Law no.46 from 21st January 2003, published in Monitorul Oficial no.51 from 29th January 2003, the patient is a healthy or diseased person using health services.[3]
The population that addresses the pharmaceutical unit is assisted by the specialized personnel under the same conditions, without any discrimination of age, race, financial status etc.
The patients have the right to health care of the highest quality that the society has, according to human, financial and material resources.
1.4The Relationship between the Pharmacist and the Population Addressing the Pharmacy
Patient orientation, the focus being on the patient at the expense of the medication, was made possible by the emergence of the pharmaceutical care concept. This raises the need to build a professional relationship with the patient, which requires maximum efficiency and professionalism. Focusing the pharmacist’s activity on the patient was originally made in his specialization as a clinical pharmacist.
The professional relationship between the pharmacist and the population addressing the pharmacy pursues the following:
-the pharmacist must possess good communication skills with the patient/customer;
-the pharmacist is responsible for selecting the efficient medication (from the OTC category), secure and appropriate in terms of benefit – cost, forcustomizing the patient’s pharmacotherapy;
-advises patients regarding the medication released with medical prescription, advice based on scientific analysis of the prescription, in the patient’s context;
-guides self-medication with OTC medicines, known and requested by the patient, based on the interrogation aimed in the patient’s context;
-recommends OTC medication for 1-2 days, at the patient’s request, presenting symptoms of acute illness, the recommendation being based on minimal consultation, in the area of confidentiality of the pharmacy;
-the pharmacist recommends seeing a doctor in case of an emergency and can release without medical prescription 1-2 doses of medication, the release being based on observing a severe symptomatology, which can’t be solved with OTC medication.
-monitors the patient’s medication therapy;
-solves the problems of drug therapy (drugs therapy problems – DTP or PTM) of the patient, based on creating the patient’s file with complete data (diagnosis, lab analysis, prescribed pharmacotherapy and self-medication history);
-the pharmacist is responsible for reporting adverse reactions (pharmacovigilance) of the patient suspected to drug-induced;
-advises the patient regarding proper diet correlated with diagnosis and medication; informs the patient about foods and drinks he should not consume, in relation with the medication;
-gives first aid in medical emergencies.[4]
Chapter 2
The Types of Pharmacist and Patient/Customer in Terms of the Way the Communication Is Established
2.1 The Concept of Efficient Pharmacist
Communication with the patient/customer plays an important role in a pharmacist’s professional life as it’s the fundament of this type of medical act.
Effectiveness is the ability of producing the desired results or defined before the action.
Efficiency is the ability to perform an activity with minimal resources, without affecting the quality of the results.
Sometimes pharmacists can be effective, but not efficient in their relationship with the patient, and this should be taken as an objective of improving professional skills as an efficient pharmacist can be recognized by the patient through: