Pharmacy Practice communication skills and influences on medicine

Pharmacy Practice – communication skills and influences on medicine taking Jane Portlock Professor of Pharmacy Education and CPPE tutor for Portsmouth

Learning outcomes for this lecture • - Distinguish the important features of effective communication from a theoretical perspective • - Have an appreciation of the need to develop effective communication skills in practice • - Distinguish the concepts of compliance, adherence and concordance • Therefore we are going to explore the basics of: – Communication skills for patient consultation – Influences on medicine taking • All of these will be explored in more detail and have workshops associated with them in Course E with me next academic year. 29/11/2020 2

An introduction to communication • In pairs answer the following questions: - – When will you communicate in pharmacy practice? – What are the barriers to good communication? – How can you overcome these barriers? 29/11/2020 3

Communication skills for pharmacists 29/11/2020 4

Put these statements in order of priority • • Putting the patient at the centre of healthcare Improved medicines adherence Job satisfaction and less work-related stress Being at your best in every patient consultation Fewer wasted medicines Patients understanding their medicines better Patient-centred approach to care Taking care of the patient like you would take care of your grandmother 29/11/2020 5

Patient – centred consultation • What do we mean by patient- centred consultation? • Which behaviours would a pharmacist demonstrate in a patient – centred consultation? • Which skills does a pharmacist need to be able to communicate with a patient? 29/11/2020 6

Putting patients at the centre of the consultation 29/11/2020 7

The beginning of the consultation • • Greet the patient (‘hello’) Introduce yourself Make sure you know the patient’s name Build rapport with appropriate body language and good eye contact • Smile but show empathy at appropriate times 29/11/2020 8

Asking questions • Let the patient tell their story • Open questions such as………………. • TED – ‘tell’, ‘explain’, ‘describe’ • Questions with options and leading questions • Beware! • Probing questions • ‘Can you describe that to me? ’ • Closed questions – ’yes’ or ‘no’ answers 29/11/2020 9

Listening • Reflecting back and responding to what a patient has told you will make them feel heard and understood. 29/11/2020 10

Explaining • Use an approach and language which is appropriate for each patient • Give a level of information relevant to the needs of the patient • Use pauses and check understanding • Make suggestions rather than directives • Repeat important points, write things down • Involve the patient in decisions and planning • Don’t be afraid of the patient’s questions ! 29/11/2020 11

Closing • Summarise • What are three most important things you want the patient to remember? • Allow the patient to tell you what they plan to do once they have left the consultation • Safety net – what if things don’t go to plan? • Use visual clues indicating the end of the discussion 29/11/2020 12

Overcoming the barriers • Common potential barriers in addition to those we identified at the beginning of the lecture: • Environment • Language, culture • Disability – sight, hearing, memory, learning disability, mental illness • How can the above be overcome? 29/11/2020 13

What does a medicines-related consultation look like? 29/11/2020 14

Let’s look at the Medication Related Consultation Framework • • • A – Introduction B – Data collection and problem identification C – Actions and solutions D – Closing the consultation E – Consultation behaviours • Developed by Professor Rob Horne and colleagues at the School of Pharmacy, University of Brighton. Professor Horne is now at UCL School of Pharmacy. 29/11/2020 15

Compliance, Concordance and Adherence • Terms which are commonly used in the pharmacy world • Compliance means………… • Concordance means…………………. • Adherence means…………. . • And are sometimes confused. 29/11/2020 16

Non- adherence • Unintentional non-adherence – Patient wants to follow the agreed treatment but is prevented from doing so by barriers beyond their control such as • Poor recall/forgetting to take the medicine • Difficulties in understanding the instructions • Problems using the treatment • Inability to pay for the treatment • Intentional non-adherence – Patient decides not to follow the treatment recommendations 29/11/2020 17

Intentional non-adherence • What causes intentional non-adherence? • Patients’ beliefs about medicines Perceived necessity of taking medicine versus Concerns about the consequences of taking the medicine 29/11/2020 18

Balance of concerns and perceived necessity High perceived necessity and low concern = Higher adherence Low perceived necessity and high concern = Lower adherence 29/11/2020 19

NICE National Institute for Health and Clinical Excellence • Medicines Adherence • Clinical Guideline 76 – Involving patients in decisions about prescribed medicines and supporting adherence • Key principles – Adapt consultation style to the needs of the patient – Establish the most effective way of communicating with each patient – Offer all patients the opportunity to be involved in making decisions about prescribed medicines 29/11/2020 20

NICE Medicines Adherence • Key principles – Be aware that increasing patient involvement may mean that the patient decides not the take the medicine – Be aware of the patients’ concerns and whether they believe they need them affect how and whether they will take their prescribed medicines – Offer patients information that is relevant to their condition, possible treatments and personal circumstances, and that is easy to understand free from jargon – Recognise that non-adherence is common and that most patients are non-adherent sometimes – Routinely assess adherence in a non-judgemental way whenever you dispense, review or prescribe medicines 29/11/2020 21

Professional activities • • • Medicines Use Review New Medicines Service Clinical Medication Review Medicines Optimisation Health promotion – stop smoking, EHC, alcohol, weight management, healthy eating • Healthy Living Pharmacies • More on all of these in Courses E and G 29/11/2020 22

Medicines Optimisation • Some areas of current focus: • Laxatives - review and, where appropriate, revise prescribing of laxatives for adults to ensure that they are only prescribed routinely for the short-term treatment of constipation, where dietary and lifestyle measures have proven unsuccessful or where there is an immediate clinical need. • ACE inhibitors - review and, where appropriate, revise prescribing to ensure it is in line with NICE guidance. • Antidepressants - review and, where appropriate, revise prescribing of antidepressants in adults to ensure that it is in line with NICE guidance. • Other medicines – include antibiotics, hypnotics, antidiabetic agents, corticosteroids in asthma – 15 current areas in total 29/11/2020 23