A naturalistic observation study of medication counseling practices at retail chain pharmacies
Main Article Content
Keywords
Counseling, Professional Practice, Pharmaceutical Services, Pharmacies, Pharmacists, Pharmacy Technicians, Waiting Lists, Cross-Sectional Studies, Linear Models, Texas
Abstract
Objective: This study evaluated medication counseling procedures and trends at retail pharmacies in the Houston metropolitan area through a naturalistic observational study.
Methods: A blinded cross-sectional observational study was conducted at retail pharmacies in the Houston metropolitan area. Data were collected by trained observers utilizing an observational log, to record various parameters that could have an impact on the duration of patient-pharmacist interaction in a naturalistic pharmacy practice setting. Additionally, indicators of counseling such as utilization of the counseling window and performance of show-and-tell were recorded. Statistical analyses included descriptive statistics, t-tests, Pearson correlations, ANOVAs, and multiple linear regressions.
Results: One hundred and sixty-five interactions between patients and pharmacy staff were recorded at 45 retail pharmacies from 7 retail pharmacy chains. The counseling window was utilized in only 3 (1.81%) out of 165 observations and the show-and-tell process was observed in just 1(0.61%) interaction during this study. Mean (SD) interaction time between patient and pharmacists [159.50 (84.50)] was not statistically different (p>0.05) from the mean interaction time between patients and pharmacy technicians [139.30 (74.19)], irrespective of type of the retail chain observed. However, it was influenced by the number of patients waiting in queue. Patient wait time significantly differed by the time of the day the interaction was observed, weekends and weekdays had significantly different wait times and patient interaction times Multiple linear regression analyses indicated that, patient interaction time, pharmacy chain type, initial contact (pharmacist/technician), and time of the day, were significantly associated with patient wait time whereas patient wait time, pharmacy chain type, number of patients in queue, and number of pharmacy technician were significantly associated with interaction time.
Conclusions: Our study found that the key indicators of counseling including the use of the counseling window and the show-and-tell process were absent, suggesting lack of adequate pharmacists counseling. Further studies are needed to evaluate the validity of this conclusion and the role of pharmacy services and its value towards medication use and safety.
References
2. Texas State Board of Pharmacy https://www.pharmacy.texas.gov/consumer/broch5.asp (accessed Sep 25, 2019).
3. Feifer RA, Greenberg L, Rosenberg-Brandl S, Franzblau-Isaac E. Pharmacist counseling at the start of therapy: patient receptivity to offers of in-person and subsequent telephonic clinical support. Popul Health Manag. 2010;13(4):189-193. https://doi.org/10.1089/pop.2009.0064
4. Alim U, Austin-Bishop N, Cummings G. Pharmacists in a Complex Chronic Disease Management Clinic. Can J Hosp Pharm. 2016;69(6):480-482. https://doi.org/10.4212/cjhp.v69i6.1612
5. Aaltonen SE, Laine NP, Volmer D, Gharat MS, Muceniece R, Vitola A, Foulon V, Desplenter FA, Airaksinen MS, Chen TF, Bell JS. Barriers to medication counselling for people with mental health disorders: a six country study. Pharm Pract (Granada). 2010;8(2):122-131.
6. Balough MM, Nwankpa S, Unni EJ. Readiness of pharmacists based in Utah about pain management and opioid dispensing. Pharmacy (Basel). 2019;7(1):11.
7. Sherin Pathickal RP, Sierra Swaby. The Importance of Counseling and its Impact on Medication Adherence. Available at: https://rhochistj.org/RhoChiPost/importance-counseling-impact-medication-adherence/ (accessed Sep 25, 2019).
8. Taitel M, Jiang J, Rudkin K, Ewing S, Duncan I. The impact of pharmacist face-to-face counseling to improve medication adherence among patients initiating statin therapy. Patient Prefer Adherence. 2012;6:323-329. https://doi.org/10.2147/PPA.S29353
9. Pirschel C. The Impact of Comorbidities on Patient Care. ONS Voice 2017; https://www.cancer.gov/news-events/press-releases/2013/ReportNationDec2013QandA#que12 (accessed Sep 25, 2019).
10. Kovačević M, Ćulafić M, Jovanović M, Vučićević K, Kovačević SV, Miljković B. Impact of community pharmacists' interventions on asthma self-management care. Res Social Adm Pharm. 2018;14(6):603-611. https://doi.org/10.1016/j.sapharm.2017.07.007
11. Tiao DK, Chan W, Jeganathan J, Chan JT, Perry J, Selinger CP, Leong RW. Inflammatory Bowel Disease Pharmacist Adherence Counseling Improves Medication Adherence in Crohn's Disease and Ulcerative Colitis. Inflamm Bowel Dis. 2017;23(8):1257-1261. https://doi.org/10.1097/MIB.0000000000001194
12. Surur AS, Getachew E, Teressa E, Hailemeskel B, Getaw NS, Erku DA. Self-reported and actual involvement of community pharmacists in patient counseling: a cross-sectional and simulated patient study in Gondar, Ethiopia. Pharm Pract (Granada). 2017;15(1):890. https://doi.org/10.18549/PharmPract.2017.01.890
13. Coelho RB, Costa FA. Impact of pharmaceutical counseling in minor health problems in rural Portugal. Pharm Pract (Granada). 2014;12(4):451. https://doi.org/10.4321/s1886-36552014000400002
14. Counseling for Improved Medication Adherence. Pharm Times. 2011-09-19.
15. Carpenter DM, Abraham O, Alexander DS, Horowitz K. Counseling of children and adolescents in community pharmacies: Results from a 14-day observational study. J Am Pharm Assoc (2003). 2016;56(3):266-269. https://doi.org/10.1016/j.japh.2016.03.001
16. Alfadl AA, Alrasheedy AA, Alhassun MS. Evaluation of medication counseling practice at community pharmacies in Qassim region, Saudi Arabia. Saudi Pharm J. 2018;26(2):258-262. https://doi.org/10.1016/j.jsps.2017.12.002
17. Mukattash TL, Bazzi NH, Nuseir KQ, Jarab AS, Abu-Farha RK, Khdour MR. Pharmaceutical care in community pharmacies in Jordan: a public survey. Pharm Pract (Granada). 2018;16(2):1126. https://doi.org/10.18549/PharmPract.2018.02.1126
18. Mobark DM, Al-Tabakha MM, Hasan S. Assessing hormonal contraceptive dispensing and counseling provided by community pharmacists in the United Arab Emirates: a simulated patient study. Pharm Pract (Granada). 2019;17(2):1465. https://doi.org/10.18549/PharmPract.2019.2.1465
19. Yang S, Kim D, Choi HJ, Chang MJ. A comparison of patients' and pharmacists' satisfaction with medication counseling provided by community pharmacies: a cross-sectional survey. BMC Health Serv Res. 2016;16:131. https://doi.org/10.1186/s12913-016-1374-x
20. The Unsung Role of the Pharmacist in Patient Health. The New York Times, 2019-01-29.
21. Gu H, Sun L, Jin R, Li F, Wei Y, Xie Z. Evaluation of counseling environmental alteration on pharmacy-patient communication qualifications: A case-control study. Medicine (Baltimore). 2016;95(52):e5738. https://doi.org/10.1097/MD.0000000000005738
22. D'Eon M. The science of communication, the art of medicine. Can Med Educ J. 2016 Mar 31;7(1):e1-e3.
23. McDonough RP, Bennett MS. Improving communication skills of pharmacy students through effective precepting. Am J Pharm Educ. 2006;70(3):58. https://doi.org/10.5688/aj700358
24. Hasan S. A tool to teach communication skills to pharmacy students. Am J Pharm Educ. 2008;72(3):67. https://doi.org/10.5688/aj720367
25. Ekedahl A. 'Open-ended questions' and 'show-and-tell'--a way to improve pharmacist counselling and patients' handling of their medicines. J Clin Pharm Ther. 1996;21(2):95-99. https://doi.org/10.1111/j.1365-2710.1996.tb00007.x
26. Arnet I, Holden M, Antoniou S, iPACT group (International Pharmacists for Anticoagulation Care Taskforce). Evaluation of a prompt card for community pharmacists performing consultations with patients on anticoagulation - lessons learned. Pharm Pract (Granada). 2018;16(3):1244. https://doi.org/10.18549/PharmPract.2018.03.1244
27. Wikipedia. Show and Tell. 2019; https://en.m.wikipedia.org/wiki/Show_and_tell_(education) (accessed Sep 25, 2019)..
28. Bobek E, Tversky B. Creating visual explanations improves learning. Cogn Res Princ Implic. 2016;1(1):27. https://doi.org/10.1186/s41235-016-0031-6
29. Garjani A, Rahbar M, Ghafourian T, Maleki N, Garjani A, Salimnejad M, Shamsmohammadi M, Baghchevan V, Aghajani H. Relationship of pharmacist interaction with patient knowledge of dispensed drugs and patient satisfaction. East Mediterr Health J. 2009;15(4):934-943.
30. Shi R, Quinones A, Bair J, Hopkins RO, Butler AM, Inglet S, Anctil C, Woods J, Jones J, Bledsoe JR. Patient utilization of prescription opioids after discharge from the emergency department. Am J Emerg Med. 2019 [Epub ahead of print]. https://doi.org/10.1016/j.ajem.2019.158421
31. Gupta S, Shaw J. Development of medication-related counselling skills in senior medical students: a checklist-based approach. BMC Med Educ. 2019;19(1):335. https://doi.org/10.1186/s12909-019-1773-x
32. Sedgwick P, Greenwood N. Understanding the Hawthorne effect. BMJ. 2015;351:h4672. https://doi.org/10.1136/bmj.h4672
33. Kimberlin CL, Jamison AN, Linden S, Winterstein AG. Patient counseling practices in U.S. pharmacies: effects of having pharmacists hand the medication to the patient and state regulations on pharmacist counseling. J Am Pharm Assoc (2003). 2011;51(4):527-534. https://doi.org/10.1331/JAPhA.2011.10012
34. Kelly DV, Young S, Phillips L, Clark D. Patient attitudes regarding the role of the pharmacist and interest in expanded pharmacist services. Can Pharm J (Ott). 2014;147(4):239-247. https://doi.org/10.1177/1715163514535731
35. Thomas D, Joseph J, Francis B, Mohanta GP. Effect of patient counseling on quality of life of hemodialysis patients in India. Pharm Pract (Granada). 2009;7(3):181-184. https://doi.org/10.4321/s1886-36552009000300009
36. Odukoya OK, Chui MA, Pu J. Factors influencing quality of patient interaction at community pharmacy drive-through and walk-in counselling areas. Int J Pharm Pract. 2014;22(4):246-256. https://doi.org/10.1111/ijpp.12073
37. Ludy JA, Gagnon JP, Caiola SM. The patient-pharmacist interaction in two ambulatory settings--its relationship to patient satisfaction and drug misuse. Drug Intell Clin Pharm. 1977;11(2):81-89. https://doi.org/10.1177/106002807701100203
38. Driesenaar JA, De Smet PAGM, van Hulten R, Noordman J, van Dulmen S. Cue-Responding Behaviors During Pharmacy Counseling Sessions With Patients With Asthma About Inhaled Corticosteroids: Potential Relations With Medication Beliefs and Self-Reported Adherence. Health Commun. 2016;31(10):1266-1275. https://doi.org/10.1080/10410236.2015.1062974
39. Sederstrom J. Four ways Pharmacists Can Improve Patient Counseling Skills. 2018; https://www.drugtopics.com/article/four-ways-pharmacists-can-improve-patient-counseling-skills (accessed Sep 25, 2019).
40. Fritsch MA, Lamp KC. Low pharmacist counseling rates in the Kansas City, Missouri, metropolitan area. Ann Pharmacother. 1997;31(9):984-991. https://doi.org/10.1177/106002809703100905
41. Santos AP, Mesquita AR, Oliveira KS, Lyra DP Jr. Assessment of community pharmacists' counselling skills on headache management by using the simulated patient approach: a pilot study. Pharm Pract (Granada). 2013;11(1):3-7. https://doi.org/10.4321/s1886-36552013000100002