During the 2021 Total Pharmacy Solutions Summit, held virtually on September 25 in partnership with Drug Topics®, Sneha Baxi Srivastava, PharmD, BCACP, CDCES, DipACLM, associate professor/associate director of skills education, clinical pharmacist, Rosalind Franklin University Medicine and Science, provided attendees with advantageous strategies and tips for pharmacists to prioritize and successfully implement patient-centered communication strategies. The session offered continuing education (CE) credits to attendees.
Srivastava emphasized the importance of seeing patients as complex individuals in order to achieve patient-centered care (PCC). When communicating with patients, pharmacists should:
- Understand the patient’s complete illness experience, including social, psychological, and biomedical factors,
- Promote an equitable relationship with all patients,
- Create a “therapeutic alliance,” and
- Develop self-awareness of the personal effects on patients.
Pharmacists are already highly trusted health care professionals and are often one of the most accessible health care providers in their community. When patients can express their questions and concerns to a supportive pharmacist who is equipped with effective PCC strategies, health and well-being can be significantly improved.
Successful communication starts with a welcoming environment, Srivastava explained. Having dedicated spaces for wellness services and pharmacist consultations are some ways to accomplish this. In one study, investigators found that “a person in the pharmacy wants the availability of health and wellness services,” Srivastava said. “And so, this might be something that you consider, and that could be a great…starting point to then have these conversations with your patients.”
Of course, the consequences of ineffective communication between the pharmacist and patient can lead be serious and include lower use of preventative services such as mammograms, pap smears, digital rectal exams, and vaccinations; increased risk of mismanaging chronic conditions and treatments; increase in preventable hospitalizations; higher health care costs; reduced quality of life; and increased morbidity and mortality. In the absence of research-based knowledge and empathetic counsel, patients can experience worse health outcomes. Srivastava pointed to a Health Care Quality Survey to demonstrate these consequences. Survey respondents reported the following results:
- Thirty-nine percent disagreed with what the clinician wanted to do (in terms of recommended treatment)
- Twenty-seven percent were concerned about cost
- Twenty-five percent found the instructions difficult to follow
- Twenty percent felt it was against their personal beliefs
- Seven percent reported they did not understand what they were supposed to do
“It’s data like this that brings me to talk about the skills and those little things we can change in our day-to-day encounters to hopefully impact these numbers,” Srivastava said.
Medication adherence can be significantly impacted by effective communication, according to Srivastava. She cited a graphic that shows, of 100 prescriptions written, an estimated 50-75 are filled by the pharmacy; 48-66 are picked up from the pharmacy; 25-30 are appropriately taken; and a mere 15-20 of those initial 100 prescriptions are refilled. Though communication is not the only factor affecting these refill rates, Srivastava explained that PCC is a strategy all pharmacists can take to make an impact.
Patient satisfaction is directly linked to having effective communication between patient and pharmacist. Core elements of patient satisfaction include:
- Time spent,
- Clinical team,
- Continuity of care, and
A common theme underlying many of these elements is patient empowerment. According to Srivastava, by listening intently to patient experiences with other health care providers, pharmacists can teach patients how to take control of their wellness journey through the notion of health literacy. “Low health literacy means that [the patient is] not able to use or understand the information that’s presented to them in a way that can optimize health care,” she said. Low health literacy is not necessary determined by a patient’s literacy in general but is more closely related to their past and present relationships with health care providers and the health and wellness resources they have access to.
Ways pharmacists can improve health literacy with patients include confirming that they’re understanding the information that is being presented to them and involving them in the decision-making process. Pharmacists can use the teach-back method, in which they ask the patient to repeat what was discussed during the consultation. “When you teach a patient how to use that glucometer, or that insulin pen, or that inhaler for asthma, taking a step back and saying ‘Okay, now show me how you’re going to use it,’ and I cannot tell you how many times that, when I do that and find they need more help,” said Srivastava. Pharmacists also should not feel the need to hide the fact that they’re making sure the patient understands the information.
Srivastava underscored the idea that patients are individuals and implementing effective communication is not an easy feat. She pointed to the Health Belief Model as a valuable resource for understanding health behaviors. “One thing that helps me is taking take a step back and thinking about each person and think about, ‘Alright, what is guiding them to make their decisions?” Srivastava said. Health behaviors are largely determined by patient perceptions, including:
Perceived susceptibility – What is the risk of acquiring an illness or vulnerability to an illness/disease?
Perceived severity – How serious is it to get the illness/disease and/or leave it untreated or undertreated?
Perceived benefit – How effective are the treatments or actions to prevent the illness/disease?
Perceived barriers – What are the obstacles present in applying the health behavior actions?
Cues to action – What is the stimulus to trigger the decision to take the recommended action?
Perceived self-efficacy – What is the level of confidence in ability to successfully perform the recommended action?
Taking the time to genuinely understand the perceptions and motivations behind a patient's health behavior and outlook can be vital to enhancing communication. In addition, what drives the patient to take action is an equally important factor for pharmacists to take note of. While some patients prefer to simply be told what to do by their health care provider, others require more time and attention to achieving their health goals. “For somebody, having external cues, like putting sticky notes on the mirror or having an alarm set [is helpful],” Srivastava explained.
In addition to enhanced patient outcomes, applying effective patient communication strategies can also mean a more successful pharmacy business. Customers are increasingly demanding patient-friendly wellness and consultation spaces, and the pharmacy is the ideal location for these services. “When we think about…how we can improve patient satisfaction, that increases patient outcomes. And we become a pharmacy practice…that people talk about.”
- Srivastava SB. CE Session: Strengthening Pharmacist Communication Skills to Enhance Patient Health and Well-being. Total Pharmacy Solutions Summit 2021; September 25, 2021; online. Accessed September 25, 2021.