1. Professor of Pharmacy Education and CPPE tutor for Portsmouth
Pharmacy Practice – communication skills and influences on medicine taking
Jane Portlock
Professor of Pharmacy Education and CPPE tutor for Portsmouth
10/11/2018

2. 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.
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3. 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?
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4. Communication skills for pharmacists
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5. 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
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6. 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?
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7. Putting patients at the centre of the consultation
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8. 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
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9. 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
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10. Listening
Reflecting back and responding to what a patient has told you will make them feel heard and understood.
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11. 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 !
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12. Closing
Summarise
What are the 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
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13. 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?
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14. What does a medicines-related consultation look like?
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15. 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.
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16. Compliance, Concordance and Adherence
Terms which are commonly used in the pharmacy world
Compliance means……………………
Concordance means………………….
Adherence means……………………..
And are sometimes confused.
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17. 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
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18. 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
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19. Balance of concerns and perceived necessity
High perceived necessity and low concern = Higher adherence
Low perceived necessity and high concern
= Lower adherence
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20. 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
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21. 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 and 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
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22. 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
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23. 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
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