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Putting patients at the centre of care in pharmacy

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Putting patients at the centre of care in pharmacy

In the first of a series of articles, community pharmacist Reena Barai explains why patient-centred care is a must for all pharmacists.

Well done for reading this article. It means you take your personal development seriously and you have somehow managed to get the time to take the magazine out of its wrapper or accessed this website! As a community pharmacist I know what it is like – time is scarce and the day job can consume us to the detriment of everything else.

Throughout this series of articles I hope to share some of the theory and some real life scenarios to encourage you to hopefully turn delivering patient-centred care from a ‘nice to do’ option into a ‘must do’ every-time situation. Some of you may remember receiving a publication called Consultation Skills for Pharmacy Practice from CPPE last spring. I hope you also took it out of the wrapper! I also hope you have visited the consultationskillsforpharmacy.com website.

If you haven’t, then please take a look. I was fortunate enough to be involved in the Task and Finish group that led to the development of the practice standards for Consultation Skills for Pharmacy Practice. This experience has totally changed the way in which I talk to patients, how I deliver services and how I train my pharmacy team. This is one of the reasons I feel compelled to share my stories with you, as I hope you will also get the same personal and professional satisfaction from making these changes as I have.

Light bulb moment

For me, one of the earliest ‘light bulb’ moments was the acknowledgement that while I may be perceived as the medicines expert, actually the patient is also an expert – in him/herself. This is one of the fundamental concepts of patient-centred care. Another point to bear in mind is that patients are autonomous and may not always do what you think is right, or what the evidence suggests they do.

Recently I was speaking to a colleague who had carried out a new medicine service consultation on a patient who had been prescribed dapaglifozin. The patient had taken it for five days and couldn’t bear the side-effects, so had stopped the treatment. My colleague explained that he had tried but couldn’t convince the patient to continue taking the tablets.

This is a common trap we all fall into as healthcare professionals. Our role is not necessarily to ‘convince’ patients to take their medicines, but to explore patients’ beliefs and experiences about their treatment in a non-judgemental way and then support them to make a decision. Sometimes within the constraints of time and paperwork, when delivering the NMS it can be easy to slip into automatic pilot and run through the list of questions without actually opening up the conversation.

I have changed some of the questions I ask during a NMS consultation with the result that I have actually had a more meaningful conversation with the patient.

Alternative wording

So, instead of asking:

• “Are you having any problems with your new medicine?” Try asking: “What concerns have you had about your new medicine, if any?” The slight change in the wording from “problems” to “concerns” automatically allows the patient to share some of their health beliefs about the medication that has been prescribed.

• “Do you think it is working?” Try asking: “How well do you think the medicine is working?” I have found that this change of wording usually allows me to explore what the patient understands about their health condition and its control and management.

• “Have you missed any doses of your new medicine?” Try asking: “How many doses have you missed in the last week?” I like this way of asking the same question, as nine out of 10 times I find patients are more honest with the answer, instead of just saying a simple yes or no.

Some of the subtle word-play changes described can make such a difference to the way in which our questions are received by the patient and in their responses. There is a wealth of evidence that shows delivering patientcentred care improves health outcomes, patient experiences and has lasting benefits for patients. Surely this is why all of us should make it a ‘must do’ aspect of our practice.

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