PHRM 3900:PHRM 3900:Pharmacy CommunicationsPharmacy Communications

Matthew Perri, Ph.D., R.Ph.Matthew Perri, Ph.D., R.Ph.Professor of PharmacyProfessor of Pharmacy

Clinical and Administrative PharmacyClinical and Administrative PharmacyRoom 260C Ph:542-5365Room 260C Ph:542-5365

mperri@mail.rx.uga.edumperri@mail.rx.uga.edu

Communications ToolboxCommunications Toolbox

Notice this one is empty…

Plan for today:Plan for today:

Course overview & introductionCourse overview & introduction– ID CardsID Cards

Name, where you are from, any prior degrees, something about Name, where you are from, any prior degrees, something about yourself that will help me remember youyourself that will help me remember you

– Course Web pageCourse Web page

The pharmacy care processThe pharmacy care processOBRA 90 and Pharmacy CareOBRA 90 and Pharmacy CareCommon communication mistakes health practitioners Common communication mistakes health practitioners makemakeBasic communication skillsBasic communication skills

The Pharmacy Care ProcessThe Pharmacy Care Process

Collect and use patient information

Identify patients’ drug related problems

Develop solutions to these problems

Select and recommend therapies

Follow up to assess patient outcomes

OBRA 90:OBRA 90:

Three parts:Three parts:– Patient InformationPatient Information– Prospective Drug Utilization ReviewProspective Drug Utilization Review– Patient CounselingPatient Counseling

Public Law 101-508, S4401, 1927(g) (November 5, 1990) and OBRA 90 Regulations.  Federal Register November 2, 1992;57FR(212):49397-49401.

Patient InformationPatient Information

Full nameFull nameAddress and phoneAddress and phoneDate of birth (DOB) / ageDate of birth (DOB) / ageGenderGenderDrug list (profile) including all OTC, Rx, herbal Drug list (profile) including all OTC, Rx, herbal supplements, etc.supplements, etc.Pharmacist commentsPharmacist commentsChronic medical conditions (diagnoses)Chronic medical conditions (diagnoses)Keep for 2 yearsKeep for 2 years

Prospective DURProspective DUR

Over / underutilizationOver / underutilization

Therapeutic duplicationsTherapeutic duplications

Drug-disease interactionsDrug-disease interactions

Drug-drug interactionsDrug-drug interactions

Incorrect dosage or duration of treatmentIncorrect dosage or duration of treatment

Drug allergy interactionsDrug allergy interactions

Clinical abuse - misuseClinical abuse - misuse

Patient CounselingPatient CounselingName (generic)Name (generic)Intended use and expected actionIntended use and expected actionRoute, dosage form, dosage and administration scheduleRoute, dosage form, dosage and administration scheduleSpecial directions for preparation, storage or administrationSpecial directions for preparation, storage or administrationPrecautions to be observed while takingPrecautions to be observed while takingCommon side effects, how to avoid or action required if they Common side effects, how to avoid or action required if they occuroccurTechniques for self monitoring of drug therapyTechniques for self monitoring of drug therapyPotential interactions or therapeutic contraindicationsPotential interactions or therapeutic contraindicationsRefillsRefillsWhat to do if you miss a doseWhat to do if you miss a doseAny other information THIS patient may need to ensure safe Any other information THIS patient may need to ensure safe useuse

Basic Communication Skills in Basic Communication Skills in Pharmacy PracticePharmacy Practice

The Communication ModelThe Communication Model

The communication model:The communication model:

Communication takes two Communication takes two – sender and receiversender and receiver

To optimize communication we must To optimize communication we must consider the “channel”consider the “channel”Two way flow of informationTwo way flow of informationPotential for a breakdown to occur at any Potential for a breakdown to occur at any timetimeBarriers will exist – minimize these when Barriers will exist – minimize these when you canyou can

Communications Skills in Pharmacy Practice, Tindall, Beardsley and Kimberlin, third ed., 1994, Lea and Febiger, p 15.

Barriers to communicationBarriers to communication

Pharmacy EnvironmentPharmacy Environment

Barriers to communicationBarriers to communication

Pharmacy EnvironmentPharmacy Environment

Barriers to communication

Basic Counseling and Basic Counseling and Communication SkillsCommunication Skills

Courtesy and rapport: Courtesy and rapport: – Quite possibly the most critical skills you will Quite possibly the most critical skills you will

need to develop, and includes:need to develop, and includes:How to address patients How to address patients Introducing yourselfIntroducing yourselfLearning patient namesLearning patient namesBeing aware of your appearance, attitude, issuesBeing aware of your appearance, attitude, issuesRespecting patient privacy issuesRespecting patient privacy issuesAvoiding stereotypesAvoiding stereotypesUsing appropriate body languageUsing appropriate body language

Body LanguageBody LanguageMessage impact: Message impact:

7% verbal7% verbal

38% vocal38% vocal

55% body movements55% body movements

Often more believable than wordsOften more believable than words

Composed ofComposed ofBody movementsBody movements

Facial expressionFacial expression

Gestures Gestures

Posture and breathingPosture and breathing

SpaceSpace

Basic Counseling and Basic Counseling and Communication SkillsCommunication Skills

Body language (we will spend more time on Body language (we will spend more time on this later)this later)– Facial expression – smileFacial expression – smile– Eye contactEye contact– Open postureOpen posture– DistanceDistance– Tone of voiceTone of voice– Get “CLOSER”Get “CLOSER”

– Control distractions, lean in, open posture, smile, make Control distractions, lean in, open posture, smile, make good eye contact, relaxgood eye contact, relax

Some samples of facial body language….Some samples of facial body language….

Bringing it home to pharmacy, is this an Bringing it home to pharmacy, is this an example of good body language for a example of good body language for a pharmacist?pharmacist?

StereotypesStereotypes

The process of attributing a set of The process of attributing a set of characteristics to all members of a group, characteristics to all members of a group, without regard for individual differences.without regard for individual differences.– We all react differently to different kinds of people, and even differently We all react differently to different kinds of people, and even differently

at different times. Some reactions are overt, some hidden. They all can at different times. Some reactions are overt, some hidden. They all can impact how we relate to patients. We want to avoid letting stereotypes impact how we relate to patients. We want to avoid letting stereotypes influence how we react to and interact with our patients.influence how we react to and interact with our patients.

– Example statements:Example statements:““Doctors are arrogant”Doctors are arrogant”

““You can’t trust…(fill in with your favorite; men, women, college students, professors, You can’t trust…(fill in with your favorite; men, women, college students, professors, etc.)”etc.)”

““Teenagers are irresponsible” Teenagers are irresponsible”

Hugman, B. Healthcare Communications, Pharmaceutical Press 2009: p50.

A stereotype in action:A stereotype in action:

I’m not feeling very well – I need a doctor immediately. Ring the nearest golf course.

Groucho Marx

StereotypesStereotypes

Common and most everyone holds to Common and most everyone holds to some degree of stereotyping some degree of stereotyping

What is the impact of this on rapport? What is the impact of this on rapport?

Being aware of how you may stereotype others is Being aware of how you may stereotype others is criticalcritical

Treat everyone as an individualTreat everyone as an individual

RapportRapport

A level of mutual consideration and A level of mutual consideration and respectrespect

– The “warm fuzzy” part of communicationThe “warm fuzzy” part of communication– Paves the way for good communicationPaves the way for good communication

Trust is criticalTrust is critical– How do you build trust?How do you build trust?– How do you keep it?How do you keep it?– What happens when you break it?What happens when you break it?

Perceptions

FINISHED FILES ARE THE RE-FINISHED FILES ARE THE RE-

SULT OF YEARS OF SCIENTIF-SULT OF YEARS OF SCIENTIF-

IC STUDY COMBINED WITH THE IC STUDY COMBINED WITH THE

EXPERIENCE OF MANY YEARSEXPERIENCE OF MANY YEARS

OF EXPERTSOF EXPERTS

ListeningListening

Basic Skills: ListeningBasic Skills: Listening

Listening Skills:Listening Skills:– Be aware of perceptions (F Be aware of perceptions (F

test) test)

– Be non-judgmentalBe non-judgmental

– Be an active listenerBe an active listener

Summarizing, Summarizing, paraphrasing, clarifying, paraphrasing, clarifying, feedback (immediate, feedback (immediate, honest and supportive)honest and supportive)

– Use appropriate listening body Use appropriate listening body languagelanguage

– Use silence where appropriateUse silence where appropriate

Listening Skills:Listening Skills:– Sit up.Sit up.

– Look and act interested.Look and act interested.

– Lean forward.Lean forward.

– Actually Listen!Actually Listen!

– Nod your head to show your Nod your head to show your attention.attention.

– Make eye contact with the Make eye contact with the speaker.speaker.

Basic Skills: InformationBasic Skills: InformationWhen communicating important information When communicating important information to patients, be sure to: to patients, be sure to:

State the purpose of your communicationState the purpose of your communication

Inquire about what the patient needsInquire about what the patient needs

Use markers for critical informationUse markers for critical information– ““Now, Ms. Smith, this is really important…..I need you Now, Ms. Smith, this is really important…..I need you

to…”to…”

Talk in lay terms, but don’t oversimplifyTalk in lay terms, but don’t oversimplify– Avoid technical jargonAvoid technical jargon– Avoid information overloadAvoid information overload– Keep it short and simple, to the pointKeep it short and simple, to the point

Basic Skills: Gathering Basic Skills: Gathering InformationInformation

When gathering informationWhen gathering information– Ask open-ended questionsAsk open-ended questions

Much more information can be gainedMuch more information can be gained

Saves timeSaves time

Provides opportunities for patients to reveal Provides opportunities for patients to reveal information we might not be thinking about information we might not be thinking about

– ““How are you supposed to be taking this…?How are you supposed to be taking this…?– ““Tell me more about this…”Tell me more about this…”

Basic Skills: AssessmentBasic Skills: Assessment

The question is, did your patient learn anything The question is, did your patient learn anything from you? In other words, did the other person from you? In other words, did the other person understand what you said, and meant?understand what you said, and meant?

To assess:To assess:– Summarize your teachingSummarize your teaching– Verify what your patients knowVerify what your patients know

““Ms. Smith, can you tell me how you will take your Ms. Smith, can you tell me how you will take your medication?medication?

– Reinforce patient understanding when you canReinforce patient understanding when you can““That’s right, this medication will make you sleepy…”That’s right, this medication will make you sleepy…”

Basic Skills: EmpathyBasic Skills: Empathy

Seek to understand what your patients feel Seek to understand what your patients feel Empathy is not sympathyEmpathy is not sympathy

Realistically, may not be attainable because you Realistically, may not be attainable because you are not the other personare not the other person

Empathy will help you shape your communication Empathy will help you shape your communication so that others better understand you!so that others better understand you!

Listening and Responding Test: (p47 Listening and Responding Test: (p47 Tindall Book)Tindall Book)

Basic Skills: QuestionsBasic Skills: Questions

Encourage patients to ask questionsEncourage patients to ask questions

– ““Just let me know if you have any other questions, OK?Just let me know if you have any other questions, OK?

Key Point: Key Point: When your patients are When your patients are comfortable asking you questions, you comfortable asking you questions, you know you have rapport and are doing a know you have rapport and are doing a good job communicating.good job communicating.

Basic Skills: Assertiveness and Basic Skills: Assertiveness and Persuasion Persuasion

Assertive versus aggressive. Assertive versus aggressive. Persuasive versus pushy.Persuasive versus pushy.

– What is the difference?What is the difference?

Counseling Methods We Will Counseling Methods We Will Learn:Learn:

Basic CounselingBasic Counseling– Interactive patient counselingInteractive patient counseling

The Prime QuestionsThe Prime Questions

Counseling in challenging situationsCounseling in challenging situations– The PAR techniqueThe PAR technique

Prepare, assess and respondPrepare, assess and respond

Counseling for complianceCounseling for compliance– The RIM techniqueThe RIM technique

Recognize, identify and manageRecognize, identify and manage

Face Reading: Art not ScienceFace Reading: Art not Science

LightLight

ForeheadForehead

Eyebrows: shape, Eyebrows: shape, position, typeposition, type

Eyes: spacing, angle, Eyes: spacing, angle, bulging, size of iris, corner bulging, size of iris, corner indents, pupil response, indents, pupil response, showing stressshowing stress

EyelidsEyelids

EyelashesEyelashes

Eye PuffsEye Puffs

Nose: size, shape, ridge, Nose: size, shape, ridge, width, nose tip angle,width, nose tip angle,

Nose tipNose tip

NostrilsNostrils

Ears: size, cups and ridges, Ears: size, cups and ridges, angle to head, placementangle to head, placement

CheeksCheeks

Mouth: size, angleMouth: size, angle

Lips: size and shapeLips: size and shape

TeethTeeth

SmilesSmiles

ChinsChins

Combinations of features Combinations of features

(Chin/eyebrow(Chin/eyebrow))LinesLines

Facial hairFacial hair

Fulfer, Mac, J.D., Amazing Face Reading, 1996.