Midterm Review

What best defines the ‘medical model’?

Focusing on the disease or biological problem, diagnosing and treating based on objective data and clinical findings.

What best defines ‘patient-centered care’?

Focuses on the whole person, understanding the patient’s experience, values, beliefs, and preferences in order to collaborate on care decisions.

What qualities best align with the ‘medical’ model?

Passive patient role, patient is recipient of treatment, physician dominates the conversation, care is disease-centered, physician does most of the talking, patient may or may not adhere to treatment plan.

What qualities best align with the ‘patient-centered-care’ model’?

Active patient role, patient is a partner in the treatment plan, physician collaborates with the patient, care is quality-of-life centered, physician listens more and talks less, patient is more likely to adhere to treatment plan.

What are some things that help foster patient-centered-care as a pharmacist?

Understand all aspects of the patient’s illness experiences, perceiving each patient as a person, foster a more egalitarian relationship, building a “therapeutic alliance”, defining mutually agreed-upon goals for treatment, developing self-awareness.

Which organization is responsible for creating the Pharmacist Patient Care Process (PPCP)?

Joint Commission of Pharmacy Practitioners (JCCP)

What are the steps of the Pharmacist Patient Care Process?

Collect, Assess, Plan, Implement, Follow-Up

What statement best aligns with ‘Collect’ of the Pharmacist Patient Centered Care process?

The pharmacist looked through H.T.’s blood pressure reading records from home.

What statement best aligns with ‘Assess’ of the Pharmacist Patient Centered Care process?

HT’s pharmacist determines that an average BP of 156/92 for the past two weeks is too high.

What statement best aligns with ‘Plan’ of the Pharmacist Patient Centered Care process?

The pharmacist discusses with H.T. about the benefits of increasing his daily lisinopril from 5 mg to 10 mg.

What statement best aligns with ‘Implement’ of the Pharmacist Patient Centered Care process?

H.T. agrees, and decides to take lisinopril 10 mg by mouth every morning.

What statement best aligns with ‘Follow-Up’ of the Pharmacist Patient Centered Care process?

The pharmacist asked H.T. to look out for any dizziness and to return for follow up with blood pressure records in the next 2-4 weeks depending on H.T.’s availability.

What skill plays a role in every step of the Pharmacists’ Patient Care Process (PPCP)?

Communication

What two things are accomplished when patient-centered care and PPCP are used together?

Establishes ongoing trusting relationship between pharmacist and patient

Enhancement of patient safety and more accurate evaluation of effect of treatment on patient’s quality of life.

What best defines the ‘Interpersonal Communication Model’ (ICM)?

A process of an interaction between two individuals.

What are the five elements to the ‘Interpersonal Communication Model’ (ICM)?

Sender, Receiver, Message, Feedback, and Barriers

What best defines ‘Sender’ in the Interpersonal Communication Model (ICM)?

The one who transmits a message to another

What best defines ‘Receiver’ in the Interpersonal Communication Model (ICM)?

The one who receives and translates the message (verbal/nonverbal)

What best defines ‘Barriers’ in the Interpersonal Communication Model (ICM)?

Interference(s) that affect the accuracy of communication exchange

What best defines ‘Message’ in the Interpersonal Communication Model (ICM)?

An element that is transmitted from one person to another

What best defines ‘Feedback’ in the Interpersonal Communication Model (ICM)?

A process that receivers communicate back to senders their understanding of the sender’s message verbally and nonverbally.

What are examples of ‘Messages’ in the Interpersonal Communication Model?

Thoughts, ideas, emotions, verbal and nonverbal information/cues

What best defines a ‘Feedback Loop’ in the Interpersonal Communication Model?

The process through which the receiver responds to the sender’s message, allowing the sender to assess whether the message was understood as intended and to adjust communication accordingly.

What conversational tool should be used to verify information in interpersonal communication (e.g. patient/provider)?

Feedback

What is an example statement of ‘Feedback’ in interpersonal communication?

“I want to be sure I have explained things clearly. Please summarize the most important things to remember about this medicine.”

What are the two types of care approaches in patient interviewing?

Directed interview and nondirective

What is the purpose of the ‘directed interview’ care approach in patient interviewing?

If there is need to find out specific pieces of information

What is the purpose of the ‘nondirective’ care approach in patient interviewing?

If outcomes are unknown or somewhat ambiguous

What is an example of the ‘nondirective’ care approach in patient interviewing?

A patient’s first visit

What is an example of the ‘directed interview’ care approach in patient interviewing?

A patient’s follow up visit concerning her high blood pressure

What are the typical tools necessary to conduct a patient interview?

PPE, stethoscope, medical gloves for physical exam, blood pressure cuffs/monitoring system

By reducing noise and ensuring patient privacy, what qualities improve in the patient during the interview?

Adherence rate, attention span, retention of information, level of comprehension and willingness to provide honest opinion

What are the four steps in starting a patient interview?

Greeting patient by name

Self-introduction

Purpose of interview

Summary outline of interview

What are positive attributes in the pharmacist that improve the quality of the patient interview?

Objectivity, combination of open and close ended questions, clear goals in mind with room for patient to talk, ability to determine patient’s ability to learn specific information, brief note taking.

What are negative attributes in the pharmacist that reduce the quality of the patient interview?

Making recommendations during information gathering, jumping to conclusions, shifting of subjects, ignoring patient’s nonverbal messages, inattention to the patient (e.g. phone call)

What are the five components of an effective patient interview?

Listening, probing, asking sensitive questions, use of silence, establishing rapport

Instead of “why” questions during patient interviews, what other phrases should be used?

“What” or “How”

What type of questions should be avoiding during probing in patient interviewing?

Leading questions

Before asking sensitive questions in patient interviewing, what should always be done beforehand?

Make sure the questions is truly necessary.

What strategies can be used to establish rapport in patient interviewing?

Having good eye contact, using sincere/friendly greeting, being courteous during the discussion, not stereotyping or prejudging the patient, seeing each patient as unique individual

What is an effective strategy to hint towards the patient the conclusion of the interview?

A summary

What does the acronym PaCT stand for?

Patient-centered Communication Tools

What is the purpose of Patient-centered Communication Tools (PaCT) in patient interviewing?

Designed to assess patient-centered communication carried out by pharmacists

What are the five domains of patient-centered communication tools (PaCT)?

Investing in the patient, integrating the patient’s perspective, demonstrating interest and empathy, planning and education of the patient, communication with finesse

What best defines ‘Professionalism’?

The combination of all the qualities that are connected with trained and skilled people.

What best defines ‘Profession’?

A group of individuals pursuing an occupation or career based on common purpose.

How is professionalism shown in pharmacy?

Commitment to serving humanity, resolution of conflicts in a professional manner, pursuing continuous professional and leadership development, and engaging in professional associations and advocacy.

What best defines ‘Leadership’?

The process through which an individual attempts to intentionally influence another individual or group to accomplish a goal; having the capacity to lead.

What is the typical pharmacy career ladder from the top to the bottom?

Chief Pharmacy Officer

Director of Pharmacy

Medication Safety Officer

Assistant/Associate Director

Clinical/Ops/Med Safety Coordinator

Pharmacy Supervisor

Staff Pharmacist

What is the typical administrative pharmacy career ladder from the top to bottom?

CMS Office of Clinical Standards and Quality Director

CMS iQuality Improvement & Innovation Group Director

Public Health Policy Director

Hospital CEO

Hospital COO

Hospital CFO

Hospital Director (Quality, Risk Management, Population Health Management)

What does the acronym ‘IHI’ stand for?

Institute for Healthcare Improvement

What are the three components of the IHI ‘Triple Aim’ to improve leadership in healthcare?

Improve care, improve population health, and reduce costs

What best defines ‘Management’?

The conduction or supervising of something; the art or act of managing.

What are typical characteristics of a manager?

Administration, copying, maintenance, writing business plans, setting budgets, monitoring progress, “make the train run on time”, accept status quo, do things right.

What are typical characteristics of a leader?

Innovation, originality, development, select talent, coach, motivate, build trust, challenge the status quo, do the right thing.

What best defines the role of ‘titles’ in leadership?

Signify a position, where you sit on an organization chart, relative power or authority

How is true leadership obtained?

Through actions which result in respect and loyalty of the team.

Successful leaders typically show strength in what category of competencies?

Emotional Intelligence (EI)

What are the Emotional Intelligence (EI) competencies that most successful leaders have strengths in?

Self awareness, self regulation, motivation, empathy, and social skill

What are the six types of leadership styles?

Coercive, Authoritative, Affiliative, Democratic, Pacesetting, and Coaching

What statement best exemplifies the ‘coercive’ style of leadership?

“Do what I say”

What statement best exemplifies the ‘authoritative’ style of leadership?

“Come with me”

What statement best exemplifies the ‘affiliative’ style of leadership?

“People come first”

What statement best exemplifies the ‘democratic’ style of leadership?

“Workers have a voice”

What statement best exemplifies the ‘pacesetting’ style of leadership?

High performance standards

What statement best exemplifies the ‘coaching’ style of leadership?

Personal development

What best defines hard skills?

Skills related to knowledge and training

What best defines soft skills?

Skills related to behavioral training

What are the common leadership styles?

Autocratic, Bureaucratic, Coaching, Democratic, Pacesetter, Laissez-faire, Servant, Visionary

What are some effective ways to develop your leadership style?

Experiment, Seek a mentor, Ask for feedback or coaching, and be authentic

What best defines ‘verbal communication’?

Communication through one medium

What best defines ‘nonverbal communication’?

Communication through several channels of communication.

What are examples of verbal communication?

Words used to express ideas, thoughts, feelings, etc.

What are examples of nonverbal communication?

Kinesics, proxemics, and elements of the environment

What best defines ‘cue clusters’ in nonverbal communication?

Combinations of nonverbal acts that communicate certain messages

What best defines ‘kinesics’?

The study of body movements and gestures in nonverbal communications

What best defines ‘proxemics’?

The use of structure and space to account for the distance between two or more interacting persons.

What are examples of some environmental factors that can affect nonverbal communication to patients?

Decor, lighting, colors, and use of space

What characteristic can affect interpretation of nonverbal communication?

Cultural factors/cultural relativity

What are skills necessary to be a good listener in any patient/provider interaction?

Summarizing, paraphrasing, and empathetic responding

What best defines paraphrasing?

A summary technique that allows you to condense aspects of the content and some superficial recognition of the patient’s attitudes or feelings.

What are examples of some obstacles in establishing a healthy patient/provider relationship?

Stereotyping, depersonalizing, and controlling behavior

What best defines stereotyping?

Forming a fixed and often untrue or only partly true idea about people or groups

What are the types of communication barriers in motivational interviewing?

Environmental, personal, administrative, and time

What acronym can be used to remember the communication barriers in motivational interviewing?

TAPE

What are some examples of healthcare professional personal barriers in motivational interviewing?

Low self-confidence, shyness, dysfunctional internal monologue

What are some examples of patient personal barriers in motivational interviewing?

Perception of healthcare professionals, perception of medical conditions, and perceptions on the healthcare system

What are examples of administrative barriers in motivational interviewing?

Workflow, staffing, and types of business plans

What is an example statement of a pharmacist making a false assumption about patient understanding?

Once patients start taking their medications correctly, they will continue to take them correctly in the future.

What are examples of techniques to improve patient understanding in motivational interviewing?

Emphasis of key points, explicit instructions, feedback, and supplemental written information with oral instructions

What best defines ambivalence in motivational interviewing?

A state of contradictory emotions at the same time related to the same situation.

What best defines approach-avoidance conflict?

Vacillation between indulging in and resisting the old behavior

What are the five needs in motivational interviewing for facilitating behavioral change?

Economic/financial security, control, recognition, belonging, and personal self-worrth

What is an example statement in motivational interviewing that may indicate a need for economic/financial security?

Cigarettes are now more than $10 bucks a pack in California, and most of that is taxes! Years ago, they were only a buck!

What is an example statement in motivational interviewing that may indicate a need for control?

Sometimes I wonder who is in charge, me or the cigarettes. I can’t even sit through a movie without going out for a cigarette. After break at work, I start watching the clock to my next cigarette at lunch.

What is an example statement in motivational interviewing that may indicate a need for recognition?

I used to think that smoking was cool in high school; now I am conscious that my clothes smell and I use tooth whiteners.

What is an example statement in motivational interviewing that may indicate a need for belonging?

At Thanksgiving or Christmas dinner, my sister makes me go outside by myself because she says I am the only one who stinks.

What is an example statement in motivational interviewing that may indicate a need for personal self-worth?

I have two children, Amy and Andy. They hate my smoking.

What acronym can be used to remember the five key concepts of motivational interviewing?

READS

What are the five key concepts of motivational interviewing?

Roll with resistance, express empathy, avoid arguing, develop discrepancy, and support self-efficacy.