Communication Strategies in Pharmacy (ACCP/ASHP 2025 Ambulatory Care Pharmacy Preparatory Review and Recertification Course)

200 practice flashcards covering key concepts from the lecture: verbal and nonverbal communication, health literacy, patient education, adherence, documentation, and interprofessional communication.

What is the primary objective of Learning Objective 1 in this chapter?

Develop patient rapport, foster trust, and efficiently obtain accurate histories by using strategies that overcome communication barriers.

What does BATHE stand for in patient interviewing?

Background, Affect, Troubling, Handling, and Empathy.

What is the BATHE method used to identify in patients?

Data and patient perspective on problems that have an emotional component or affect quality of life.

What does PQRST stand for in history taking?

Provocative/Palliative, Quality, Region, Severity, Timing.

What is the variant OPQRSTUV used for?

A detailed history approach for symptoms including Onset, Provoking, Quality, Region, Severity, Treatment, Understanding impact, and Value.

What does SCHOLAR-MAC stand for in symptom assessment?

Symptoms, Characteristics, History, Onset, Location, Aggravating factors, Remitting factors, Medications, Allergies, Conditions.

What does the SOLER acronym describe?

Body language: Squarely face the patient, Open posture, Lean toward patient, Eye contact, Relax.

What is the purpose of the PQRST method in pain assessment?

To obtain a comprehensive description of the problem including Provocation, Quality, Region, Severity, and Timing.

What does the SCHOLAR-MAC mnemonic help pharmacists assess?

Symptoms and related factors to properly characterize a patient’s condition.

What are the four Domain 1 skills for communicating verbally with patients?

General tips for verbal communication, developing rapport, questions use (open, prompts, probing, closed), summaries, body language (SOLER), and active listening.

What is the purpose of using open-ended questions?

To begin a topic and allow patients to share their perspectives and knowledge.

What are prompts used for in interviewing?

To help patients continue or complete their train of thought after an initial response.

What is the key purpose of paraphrased summaries in interviews?

To confirm understanding and transition to the next topic, while inviting corrections.

What is the SOLER method used to assess?

Nonverbal communication and engagement with the patient.

What does “enunciate clearly” refer to in domain B?

Modulate tone, volume, and rate of speech to improve clarity.

What is the importance of establishing a mutual agenda in patient interviews?

To set expectations and align on goals for the visit.

Name one key step when greeting a patient to establish rapport (Domain B).

Warmly greet using the patient’s preferred mode of address and gender identity.

What is the recommended time management tip for patient visits (Domain B)?

State the purpose and provide an time estimate for the interaction.

How should a pharmacist incorporate patients’ perspectives during encounters (Domain B)?

Provide opportunities to voice concerns, repeat concerns with nonjudgmental language, explain how concerns will be addressed, and offer additional sources of information.

What is health equity in the context of communication?

Using inclusive language, avoiding assumptions about gender, and ensuring culturally sensitive care.

What is “empathy” in patient interactions?

Reflect back the patient’s emotions and respond with understanding.

What should be avoided when responding to patient emotions (nonempathetic responses)?

Judgmental responses, advising, placating, generalizing, quizzing, distracting, and depersonalizing.

What is the BATHE method used for besides data collection?

Identify coping and emotional aspects related to problems.

What is the Background (B) component of BATHE?

Elicit the context and overall situation related to the problem.

What is the ‘Affect’ (A) component of BATHE?

Ask about feelings or effect on quality of life.

What is the ‘Troubling’ (T) component of BATHE?

Identify what troubles the patient most about the problem.

What is the ‘Handling’ (H) component of BATHE?

Understand how the patient is coping with the problem.

What is the ‘Empathy’ (E) component of BATHE?

Reflect back the concern and emotion to the patient.

What is the purpose of the Background, Affect, Troubling, Handling, and Empathy (BATHE) method?

To gather data and patient perspective on problems with emotional components.

What are the seven main elements of the History Taking (Domains 1, 2) discussed?

Current problem and chief concern; PQRST; optional OPQRSTUV; SCHOLAR-MAC; BATHE; follow-up visits; ROS.

What is a common opening question to begin a patient’s chief concern (Case example in notes)?

An open-ended question such as, “Tell me in your own words about the back pain you are experiencing.”

What is the practical purpose of the BATHE method in patient cases?

To identify coping and emotional aspects that affect treatment and adherence.

What are the main components of the health literacy domain concept?

Fundamental, Scientific, Cultural, Civic domains.

What is health literacy?

The degree to which individuals can obtain, process, and understand basic health information to make appropriate health decisions.

Name two risk factors for low health literacy.

Age over 65; less than a high school education; low income; English as a second language; immigrant status.

What is the NAAL?

National Assessment of Adult Literacy, which defines health literacy levels and domains.

What are the four levels of health literacy defined by NAAL?

Below basic, Basic, Intermediate, Proficient.

What is REALM?

Rapid Estimate of Adult Literacy in Medicine; a quick reading ability tool correlating with health literacy.

What is TOFHLA?

Test of Functional Health Literacy in Adults; measures reading and numeracy in medical contexts.

What is the s-TOFHLA?

A shorter version of TOFHLA with 36 reading items, administered in about 7 minutes.

What is NVS?

Newest Vital Sign; a six-question tool using nutrition labels to assess literacy and numeracy.

What is SILS?

Single Item Literacy Screener; one question about needing help reading health materials.

What is PEMAT?

Patient Education Materials Assessment Tool—evaluates understandability and actionability of materials.

What is PEMAT-A/V?

PEMAT for audiovisual materials; assesses understandability and actionability of media.

What is SAM?

Suitability Assessment of Materials; evaluates written materials across several domains.

How is the SAM scored?

Qualitative scoring across factors on a 0-2 scale; maximum is 2 points per factor.

What is an actionability domain in PEMAT?

Whether the material provides clear actions the patient can take.

What is the Health Belief Model (HBM) used for?

predicting whether a patient will participate in disease prevention or treatment.

What are the four core HBM constructs?

Perceived susceptibility, perceived severity, perceived benefits, perceived barriers.

What are the two additional HBM constructs mentioned?

Cues to action and self-efficacy.

What are the four constructs of secondary HBM?

Perceived susceptibility, severity, benefits, barriers; plus cues to action and self-efficacy.

What is the Adherence Estimator designed to assess?

The likelihood that a patient will adhere to a newly prescribed medicine.

How many questions are in the Adherence Estimator and what scale is used?

Three questions on a 6-point scale; scores range 0-36.

What are the score interpretations for the Adherence Estimator?

0 = low risk, 2-7 = medium risk, 8-36 = high risk of nonadherence.

What does the Morisky questionnaire assess?

Predicts adherence for a disease-specific regimen; available in 4- and 8-question formats.

What is the Morisky questionnaire used for besides adherence?

Screening for knowledge gaps and motivational issues affecting adherence.

What is concordance in medication use?

A therapeutic partnership where prescriber and patient agree on decisions about treatment.

What is the difference between concordance and compliance?

Concordance emphasizes patient–provider agreement and shared decision-making; compliance emphasizes following prescriber recommendations.

What is the concept of persistence in adherence literature?

Continuing a medication beyond the first refill.

What is primary nonadherence?

Patient never fills or never initiates the prescribed medication.

What is secondary nonadherence (nonpersistence)?

Patient starts a medication but discontinues it before the course is completed.

What is improper use in medication adherence?

Taking a medication in a way not aligned with instructions (wrong dose/frequency).

What is the purpose of the ETHNIC cultural model?

Understand illness explanation, treatment, healers, negotiation, intervention, and collaboration with patient.

What are the six elements of ETHNIC?

Explanation, Treatment, Healers, Negotiate, Intervention, Collaboration.

What is the purpose of using interpreters per CLAS standards?

Provide timely language assistance without charge to patients with limited English proficiency.

What are Box 3 tips for speaking to patients via interpreters?

Brief the interpreter, speak in first person, face the patient, use normal tone, expect interpretation to occur, avoid using family members as interpreters, document interpreter use.

What are four special considerations for older adults in counseling?

Plain language, teach-back, briefer sessions, involve caregiver when appropriate, large-print materials, assess functional ability.

What is the DRUGS scale?

Drugs Regimen Unassisted Grading Scale—assesses patient ability to manage medications at home.

What types of techniques help improve self-efficacy (Box 1 ideas)?

Break tasks into steps, progress gradually, frequent follow-up, show progress, set achievable goals, brainstorm solutions, identify peer mentors.

What is the purpose of the DRUGS tool in practice?

Identify patients who need assistance managing medications at home.

What does the BATHE technique help assess beyond data collection?

Emotional coping and subjective experience with illness.

What is the purpose of teach-back in patient education?

Assess understanding by having the patient explain or demonstrate what was taught.

What is the show-me method?

Have patients demonstrate a skill to verify correct technique or dosing.

What is the purpose of a plain-language approach to communication?

Enhance understandability and reduce misinterpretation by avoiding jargon and complex terms.

What is the recommended reading level for patient materials per USP labeling principles?

Approximately a fifth-grade reading level.

What are key layout recommendations for patient education materials (SAM/PEMAT guidance)?

Chunk information with headers; use bullets; avoid long paragraphs; use white space; two-column layouts preferred.

What font and typography guidelines are endorsed for patient materials?

12-point sans-serif font (e.g., Arial); use sentence case; avoid all caps.

What is the goal of standardized prescription labeling per USP guidance?

Clear, concise instructions with explicit dosage, timing, and purpose in lay language; translations when needed.

What is SBAR an acronym for and used for?

Situation, Background, Assessment, Recommendation; used to organize and communicate patient-specific information.

What is the CUS technique used for in safety communications?

Concern, Uncomfortable, Safety—structure messages about potential safety issues.

What is the purpose of the CANDOR toolkit?

AHRQ framework to implement communication and resolution programs after adverse events.

What is the purpose of medication reconciliation as a standard process?

Identify and resolve discrepancies across transitions in care; ensure up-to-date medication lists; educate patients.

What are two key mnemonic tools used in medication reconciliation to identify meds?

MR ROSS (Medication Reconciliation Review of Systems Subject) and MRROSS approach.

What is the MR ROSS tool used for?

A pictorial tool to help patients identify medications during reconciliation.

What is an essential component of MR ROS in reconciliation?

Review of systems and substances to ensure all meds are identified.

What is the Joint Commission’s stance on medication reconciliation procedures?

Medication reconciliation is part of National Patient Safety Goals, but specific procedures are not mandated.

What should be included in an initial medication history (Domain 2)?

Prescription meds (dose, route, frequency, start date, indication); vaccines; OTCs; vitamins; supplements; allergies; social history; prior meds; devices.

Why is it important to document patient adherence behaviors in the medical record?

To support treatment decisions and track progress; inform follow-up and future interventions.

What does ‘readability’ refer to in SAM/PEMAT contexts?

How easy it is for a target audience to understand written or audiovisual health information.

What is the purpose of the PEMAT in evaluating patient education materials?

To assess understandability and actionability of materials, including audiovisual formats.

What is the health literacy domain that includes cultural beliefs and social identity in decision-making?

The Cultural domain.

What is the recommended action regarding punctuation and abbreviations on prescriptions per Joint Commission/ISMP guidelines?

Avoid abbreviations (e.g., MSO4); use explicit terms; avoid trailing zeros; write in full words when possible.

What is a common open-ended opening question for a new patient visit (Domain 1)?

“What brings you in today?” or “Tell me about your health concerns.”

What is the role of the ‘Ask Me 3’ tool in patient communication?

Encourage patients to ask: What is my main problem? What do I need to do? Why is it important?

What are the six stages of the Transtheoretical Model (TTM) as presented in the notes?

Pre-contemplation, Contemplation, Preparation, Action, Maintenance, Termination.

What is a typical pharmacist response when a patient is in the Pre-contemplation stage of change?

Respect, seek permission, and offer to help when the patient is ready.

How should a pharmacist respond to a patient in the Maintenance stage?

Reinforce progress, celebrate successes, and plan ongoing support.

What is a practical tip for counseling older adults with potential cognitive decline?

Use plain language, shorter sessions, and involve caregivers; verify understanding with teach-back.

What is the ETHNIC model used for?

Understanding a patient’s cultural beliefs about illness and treatment and negotiating a plan.

What is included in the CLA standards for interpreters?

Timely language assistance without charge; trained interpreters; avoid relying on family members.