Exploring communications around medication review in community pharmacy

Objectives Investigation into aspects that influence outcomes of medication reviews have been called for. The aim of this study was to assess how pharmacy internship students in a Danish medication review and reconciliation model communicated with both diabetes patients and the patients?? General Practitioners (GPs) when conveying the results of the review by writing letters to the different parties. Special attention was drawn to how differences in health care provider and patient perspectives of the disease as well as inclusion of the patient in the decision making process is influenced by the identified practices of communication. Setting 18 Danish community pharmacies with The Department of Pharmacology and Pharmacotherapy at the Faculty of Pharmaceutical Sciences, University of Copenhagen. Method Number of identified drug related problems, life-world problems and solutions to these described in the letters sent to patients and their GPs were registered. Further a qualitative documentary analysis was conducted by analyzing the letters using the theory of transactional analysis, developed by Berne. Main outcome measures Identified and conveyed drug related and life-world related problems when comparing patients?? letters with GPs?? letters. Whether students assumed a superior, inferior or equal role in relation to the recipient of the letter and compared whether students assumed the same role in relation to patients and GPs. Results 18 pairs of patient and GP letters were analyzed. The analysis showed that students conveyed more drug-related problems to GPs than to patients. Furthermore, students assumed an equal relationship to GPs, whereas they frequently took superior positions when writing to patients. Students reported lifestyle problems both to GPs and to patients. Conclusion Pharmacy students in a Danish medication review and reconciliation model managed to detect and address lifestyle problems of patients to their GPs, thereby facilitating the merger of their professionaltechnical perspective with the life-world perspective of patients. However, patients were not encouraged to become more involved in the disease management process.     

The pharmacy medication error peer-review committee.

A pharmacy medication error peer-review committee was established for reviewing, evaluating and, classifying medication errors occurring within or emanating from pharmacy service. The panel is charged with classifying reported errors, making recommendations for reducing and preventing errors, and making recommendations for changes in the classification system or definition of "medication errors." The panel membership allows for staff as well as administrative representation. Improved patient care and a more objective basis for administrative and/or disciplinary actions has resulted from this mechanism.     

Drug-related problems identified during geriatric medication review in the community pharmacy

International Journal of Clinical Pharmacy - Background In line with the changing role of community pharmacists, we describe here a standardised procedure for detecting DRPs in elderly patients for...     

Developing the future of pharmacy through health-system pharmacy internship programs.

PURPOSE: A summer health-system pharmacy internship program developed outside the doctor of pharmacy curriculum is described. SUMMARY: The summer pharmacy internship program was implemented in 2002. The main goal of the internship program is to develop the profession of pharmacy by providing pharmacy students an opportunity to work in various practice settings within a health system. The internship is also designed to develop students' interest in health-system pharmacy by allowing them to meet and shadow pharmacists in various specialties. Learning objectives include the development of career goals, pharmacy technical skills (e.g., sterile preparation), drug literature review (e.g., journal club), pharmacy practice and practice leadership. Students are required to start their internship one week after the end of the school year and end it one week before the beginning of their next semester of classes. The internship is a paid position, with pay being commensurate with the student's current pharmacy school year. Students spend 40 hours per week in the program, with one weekend commitment. Approximately 75% of the intern's time is spent dispensing medications, and 25% is spent in meetings, working on projects, and shadowing pharmacists. Interns meet one-on-one each week with an assigned preceptor to discuss relevant pharmacy questions and career opportunities and to provide updates about current projects. Of the six interns who have graduated from pharmacy school since this program's inception, five have pursued careers in health-system pharmacy. CONCLUSION: The summer pharmacy internship program at Johns Hopkins Hospital exposes pharmacy students to various practice settings and helps them realize the career opportunities available in health-system pharmacy.     

The 'cost' of medication nonadherence: Consequences we cannot afford to accept

ObjectiveTo provide a brief overview of the extent of medication nonadherence in the United States, its impact on patient health and health care costs, its causes, and possible strategies that health care practitioners can use to improve medication adherence.SummaryMedication use and health care costs have increased dramatically during the previous decade in the United States. Adherence to medication therapy often is a critical aspect of medical treatment, particularly the treatment of chronic conditions such as diabetes and hypertension. Despite the importance of adherence, medication nonadherence is a serious problem, with the World Health Organization noting that the average nonadherence rate is 50% among those with chronic illnesses. Consequences of nonadherence include worsening condition, increased comorbid diseases, increased health care costs, and death. Nonadherence results from many causes; therefore, no easy solutions exist. The first step to addressing nonadherence is to recognize that collaboration must occur between health care practitioners and patients to increase adherence, with the goal of achieving optimal health outcomes.ConclusionThe relationship between health care practitioners and patients and open, ongoing communication between the stakeholders are essential to combating medication nonadherence. Given their training and accessibility, pharmacists are well positioned to address nonadherence.     

Factors influencing patient participation in medication counseling at the community pharmacy: A systematic review

BackgroundFindings document that patient participation in pharmacy encounters is associated with favorable outcomes. However, there is a need to understand factors that may enhance or hinder patient engagement and pharmacist counseling behaviors during their medication discussions. This review aims to: (1) identify barriers and facilitators for patient engagement in pharmacy consultations, (2) explore the relationship between patient factors (such as demographics and communication behavior) and subsequent pharmacist counseling behavior.MethodsA systematic review of literature using PRISMA guidelines examined studies published in English addressing influences on patient participation and the relationship between patient factors and pharmacist counseling behavior. Four databases were used - PubMed, CINAHL, PsycINFO, and Scopus. Findings were framed thematically within the constructs of Street's Linguistic Model of Patient Participation in Care (LM).FindingsFifty studies from 1983 to 2019, including 37 using self-reported data, were identified. Patient involvement in patient-pharmacist communication was influenced by enabling factors such as patient knowledge, communication skills, and pharmacy environment. Predisposing factors for participation ranged from patients' beliefs and past experiences to demographic characteristics such as gender and age. Pharmacists' participative behavior with patients was positively associated with patients’ engagement and perceived patient cues in the conversation.ConclusionThis systematic review identified predictors of patients' engagement in pharmacy encounters drawing on LM framework. Various predisposing factors, enabling factors, and pharmacist’ responses impacted patients' willingness to actively participate in medication counseling at community pharmacies. Equally important, studies documented considerable impact by patients on pharmacists' counseling behavior. Pharmacy encounters should no longer be viewed as controlled simply by pharmacists’ expertise and agendas. Patient characteristics and factors such as patient question-asking and expectations also appear to be associated with and influence patient-pharmacist interpersonal communication. Additional research needs to address the identified facilitators and barriers to enhance patient participation and pharmacist counseling behavior.