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Pharmacy counter consultations should never be just a tick-box exercise

We must remember that consultations with patients should meet their individual needs because we should not be doing it just so we can say we have done our job

We all do it every day and with the best of intentions. Patients come to our dispensary to collect their medicines and we provide some “patient counselling” about their medicines: how, when and perhaps why they should take their medicine, where to store it, how long to take it for and things to avoid while taking it.

The chances are that your pharmacy, in common with most others, has a patient counselling policy or checklist for information to give about medicines and, at a guess, there will be sizable list of key points to include.

But it is useful to stop and think about who we are doing this for. We suggest that pharmacy practitioners have a perceived duty to impart certain information about medicines. By passing on key safety and administration information we are trying to support optimal and safe use of medicines. Our challenge is this: does traditional patient counselling give patients what they need or just satisfy a need in us?

It is worth taking a moment to think about what it is like to be a patient. Perhaps you are or have been a patient yourself. Perhaps the patient in front of you was waiting to see a clinician about something that has worried them; what about those who have been given an unexpected, serious diagnosis; those who are feeling confused and upset at what they have just heard, who then wait to ponder this and collect their prescription from us? How high a priority is medicines-related information for them at that time? In a hospital, what about the patient who has been seen by three or four clinicians before us and is worried about the parking meter running out? Can we reasonably expect them to focus on all the things they might want to know about a medicine and how it fits into their life (in a waiting room full of people) at the end of their hospital experience? Whatever we might say to these patients, how much will they actually take on board?

There is an excellent quotation from the National Collaborating Centre for Primary Care 2009 guidance that reads: “Informing should be an active process … involves more than simply presenting [the facts].” We focus on providing a safe process for dispensing prescriptions and communicating key information with our patients and we spend a relatively short time with them. We rarely have any knowledge of what has happened to a patient before he or she comes to see us. Given the scenarios above, how we can use this time most productively to ensure that patients get the information and support they need at the right time for them and in the right way?

Person-centred care

There is a recent imperative around developing shared decision-making and self-management as part of clinical consultations thereby improving “patient centredness” of care. Person-centred care combines the expertise of healthcare practitioners, providing information about the pros and cons of treatment options, and patients who can share information about their lifestyle, values, beliefs, concerns and preferences.

With new medicines, especially where there is a choice to be made, we know that people often need time and support to digest information, formulate questions and develop a preference about treatments and the care and support we provide should allow them to do this. The new medicine service is ideal to support patients at this time. Different people need different things to engage with decisions about medicines. For some, it is decision support tools they need to help them weigh the risks and benefits (such as those available at patient.co.uk/decision-aids). For others, it is simply time.

In long-term conditions, person-centred care improves adherence to medication, a problem high on the Quality, Innovation, Productivity and Prevention agenda. As a person’s lifestyle, health status and perception of their disease and medicines change over time, so too can the most appropriate choice of medicine or treatment regimen.

People with long-term conditions make decisions every day about whether or not they will, and how to, take their medicines and pharmacy practitioners are sometimes the only healthcare professionals they have regular contact with. We are well placed to help patients identify and address their barriers to achieving positive health outcomes through optimising how they use a medicine that is right for them. How can we make the pharmacy counter consultation more patient-centred in the time we have available?

We have some suggestions to consider. First, take a look around your waiting area. What opportunites are there for showing a film about optimal use of medicines or setting up display information that seeds the right questions in the minds of your patients? Waiting time could be spent considering what they want to know about their medicines.

We know from the literature around health coaching and shared decision-making that simple changes in our language can be powerful. So, our second suggestion is that patient encounters begin with a person-centred question. This indicates that you recognise the importance of patients’ views and needs and allows them to raise things that are important to them. Try “would you like me to go through your medicines with you?” or “what would you like to know about your medicines?”. These are good questions in other ways. Besides giving information to those who want it, it allows those who have reading difficulties to accept your offer without embarrassment and it respects those who do not want the information now, whatever the reason for that might be.

Our third suggestion is about respecting patients’ choice to accept or decline information at the counter. If patients do not want any information, then why not signpost to patient information leaflets and invite them to call your patient helpline (available in some hospitals) when they have had an opportunity to read the instructions or leaflet? There are a number of high quality medicines information websites that we can direct patients to (eg, NHS Direct, NHS 24 in Scotland or NHS Northern Ireland, www.patient.co.uk or www.nhs.uk). We suggest that this shows respect for the patient’s agenda, rather than “carrying on regardless”.

Not just a box-ticking exercise

To those who throw their hands up in horror that we have not given key safety information or gone through the medicines, we ask you to consider how helpful this is if the patient is not listening? Are you just ticking a box for yourself?

Clearly, there will be times where you think it is critical to tell them something important because of the nature of the medicine. In this case, you will be clear with the patient that it is important, keep it short and simple, reinforce it with the written information that is available (eg, monitoring book, PIL or alert card). Where you do have time to speak to patients for longer, a structured approach to the conversation, using a health coaching model previously described (PJ 2013;291:153), can be helpful in supporting patient-centred care.

We encourage you to think about how you talk to patients about their medicines and, for those running dispensaries, how standard operating procedures can be updated so that we provide an equitable, effective service both to those who are in a position to have a pharmacy consultation at the time and to those who would prefer alternative support. Further information and a wide range of training materials are available in a new person-centred care resource centre on the Health Foundation website www.health.org.uk.

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2014.11132883

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