What Pharmacists Should Know About Patient Centricity
Patient centricity is more than a buzz-word in health care and pharmacy. It is the lofty and worthy goal of recent policy and technology changes and is already affecting the way pharmacists interact with patients. Patient centricity poses unique challenges and opportunities for pharmacists.
What Holds Pharmacists Back?
The upcoming changes to the pharmacy world can feel relentless and overwhelming. Amazon is looking to come into the pharmacy business and deliver medications, pharmacy benefits managers (PBMs) are determining what medications patients have access to and what medications that pharmacists can dispense. Additionally, mail order pharmacies are starting to exercise more control. With all those changes, it’s important that pharmacists make a living by continuing to serve patients and helping them be well.
An important initial part of this process of serving patients must begin with soul-searching: Why weren’t patients always the focus? Ultimately, all health care practitioners — physicians, pharmacists, insurers, pharmaceutical companies — are in the business of patient care. It is interesting that it has taken an awareness movement to say it’s all about patient centricity. It should always have been about making sure that patients’ needs are met.
The Pharmacist’s Focus on Patient Centricity
Patient centricity does not mean the following patient experience: Patient comes in, they drop off the prescription and interact with a technician who is overworked, visibly unhappy, or dismissive to the patient. Pharmacists are aware that this is a routine occurrence.
Patient centricity is about putting the patient first and understanding the patient’s needs. It is important for patients to understand patients needs by talking to patients and understanding what they want. The patient centricity movement is a focus on care with the interest of individual patients and not about patients as a whole
While pharmacists are busy, an unsatisfactory patient experience is also both undeniable and unacceptable.
A Better Patient Experience
In the ideal scenario, the patient’s experience would include the pharmacist pulling them aside to discuss the patient’s needs, and for the patient to better understand their treatment. Another benefit to that conversation is for the pharmacist to better understand if the patient would even benefit from the medication. If the pharmacist has a conversation with the patient and discovers that the patient probably won’t take the medication because the patient does not like the side effects of the pills that were prescribed, that is an opportunity for the pharmacist to reach out to the doctor to discuss alternatives. In just a three to five minute conversation, the pharmacist is able to find out that the patient will not likely benefit from the medication at all, and a new direction for treatment can be established. An additional benefit is that potentially harmful medications will not sit unused in a medicine cabinet. But that’s the ideal, and not the reality.
Resetting to Reality
In reality, it’s not possible for a solo pharmacist to sit down with every patient and go over every medication. It is more typical for a pharmacist to sitting in the back of the pharmacy after a busy day, reading a magazine, not looking to engage with patients. It’s important to remember that pharmacists did not go to 6–8 years of college to read that magazine but to do their part in helping to make patient lives better.
Small Steps, Big Impact
Pharmacists must consider taking at least the following steps to help build a patient centric environment:
1- Learn Names
Engaging with patients by using their names has a profound impact on the patient experience.
While it is daunting for a pharmacist to memorize the name of every patient who walks through the door, recognizing patients, and making an effort to use their name can alleviate some of their stress and anxiety. A patient’s name may be the most important word to them, and using their name shows a consideration that the patient may not be used to. This action can help to align the encounter with the pharmacist’s goals of providing the best care for the patient instead of coming across as the gatekeeper to their road to better health.
In the heat of the moment, using a patient’s name can seem nearly impossible. However, with the right pharmacy staff, and the right pharmacy techs, staff that takes the time to say Hello Brenda, or Hello Tom, when they arrive can dramatically improve relationships. Pharmacists who go from saying a patient’s name to asking What brings you here? may result in patients opening up. They may respond that they have a prescription. Conversations about the prescription can lead to a conversation about their prescriptions and what they know about and want from their medication. For example, if they pick up a blood pressure prescription, it might be an opportunity to educate them about side effects and how that medication will improve their health.
Engaging the patient to help them understand their medication can help them stay on track with taking the drug, even if they experience some adverse effects. On the other hand, if they do not understand the significance, if they’re not a participant in their own care, and they are noncompliant with the medicine, pharmacists are not achieving your own goal of helping to empower patients to improve their health.
The key takeaway about patient centricity is that it engages patients in their own care, as opposed to being on the sidelines.
2 — Ask About Progress
It is surprising how rarely pharmacists ask about a patient’s experience with drugs they are already taking. Despite being the resident drug expert, pharmacists do a good job pretending that if a patient does not raise concerns over a drug, they must be doing well with it. However, far too often patients may be embarrassed to raise their concerns, may think it’s best to wait for their next annual physical to raise it with the doctor”, or worse, simply stop using the drug. It is important that pharmacists be empathetic, ask the hard questions and build the trust to adjust drugs as necessary.
3 — Avoid Jargon
Pharmacists often forget that they went through 6 years of college and may have even had residency experience after that. They routinely break out into medical jargon and may discuss why an errant creatinine clearance has affected dosing of a drug or why someone’s LFTs may affect drug dosing. It is important for pharmacists to take a step back and think about talking to someone like their mother or grandmother and trying to explain the same concept without the jargon. Efforts like this are already gaining traction in Europe and it’s important that pharmacists in the US stay ahead of the curve.
4 — Using the Repeat Technique
Even well-meaning pharmacists forget that drugs are essentially controlled poisons. Accordingly, it is important that pharmacists explain the adverse effects, goals and monitoring considerations of a drug to a patient. A trick that may help pharmacists to evaluate the understandability of counseling sessions is to ask the patient to repeat what they have just learned. This technique routinely raises miscommunications and misunderstandings and may, in some cases, avoid significant adverse events.
The Dark Side of Patient Centricity
With the good comes the bad. It is important to recognize that patient centricity does have a negative side, and pharmacists must be aware of those challenges.
Rather than seeing themselves as an active, responsible participant in their own care, patients may see patient centricity as a movement to help them get what they want out of medical care, even in situations where that might not be in their own best interest. Pharmacists may misunderstand patient centricity in this way as well. The dark side of patient centricity happens when pharmacists feel pressured to satisfy the patient, rather than engage the patient. That avoidance of responsibility creates situations like the opioid crisis, where patient demands are met rather than patient interests.
Pharmacists are the educated intermediary between a patient and a medication — their role is not simply to give the patient what he or she wants. Unfortunately, with respect to pain medication, many pharmacists struggle to have these hard conversations about addiction so they end up feeding an addiction.
In this situation, it is important that pharmacists choose to have that hard conversation. Pharmacists must need to be able to say, “I know you’ve gotten this prescription from three other doctors, and I filled them for you. I will be reaching out to your doctor. But we need to sit down. Let’s talk a little bit about what’s going on. Is your back still hurting? Because it’s been six months since you had the surgery. What is going on with these medications?”
The patient might say, “It’s none of your business.” But it is part of the pharmacist’s responsibility to ask those questions, to make sure that the prescription drug is being used appropriately and to avoid becoming a conduit to give drugs.
Every so often, there will be a pharmacist who avoids the hard conversation by proudly proclaiming, “If you call in to see if I have Oxycontin, I will say I don’t have Oxycontin.” However, this denies the responsibility owed to patients in the event they are in pain. It’s possible that the pharmacist just prevented the patient from receiving their prescription drug because of a paternalistic attitude of deciding what they need. It may make more sense to engage with the patient to understand their needs and then guiding them toward better pain management.
The focus on patient centricity as a movement should always be trending in healthcare and can only serve to increase patient engagement. From your perspective as a pharmacist, a care provider, and a person running a business, patient centricity is really in their best interest. Increasingly, patients have options of how to obtain their prescription drugs. Soon, they may be able to get their medication delivered directly to them. The care pharmacists provide them by taking an interest in their health, can never be replaced by Amazon or a mail-order service.
Patients can feel when they are genuinely cared for, and they will choose to come to their local pharmacist if they are engaged them, if the pharmacist understands their goals, and helps them achieve better health as a partner in their care.
Originally published at www.darshankulkarni.com on November 29, 2018.