PPCP, Patient-Centered Communication, Medication Education, MI

Pharmacists’ patient care process (PPCP)

framework to describe the thought process and actions of a pharmacist

Collect domain of PPCP

obtain necessary subjective and objective information about the patient from multiple sources

Assess domain

examine the information collected to identify and prioritize problems and achieve optimal care

Plan domain

develop an individualized person-centered, evidence-based, cost-conscious care plan, in collaboration with the patient/caregiver and in coordination with other care team members

Follow-up domain

follows up to monitor and evaluate the implementation of the care plan and the patient’s overall health in collaboration with patient, caregiver, and other care team members, as necessary

Middle domain

• collaborate

• communicate

• document

Patient-centered communication

• approach that prioritizes the patient’s perspective, needs, and values in healthcare interactions

• leads to development of more accurate, effective plan

• generates “buy-in” from patients

Components of listening

• eye contact

• nonverbal cues

• listen to tone

• provide feedback

• show evidence you hear them and offer a chance for them to correct you

  • do this by repeating verbatim, paraphrasing, or reframing

Components of probing

• phrasing of the question, “tell me more…”

• timing, don’t interrupt

• avoid leading questions

• open-ended

Components of asking sensitive questions

• avoid “always”, “never”

• tone of voice

• explain purpose of question

• make sure question is necessary

Components of using silence

• give patient a chance to reflect and answer

• listen twice as much as you talk

Health literacy

ability to understand health-related information

• can be clouded by worry or illness

Cultural humility

recognizes cultural differences between people, including pharmacists and patients, and the impact these can have on interpersonal interactions and patient care

Medication education

the delivery of all pertinent information regarding the safe and appropriate use of medication to a patient

Omnibus Budget Reconciliation Act of 1990 (OBRA ‘90)

• prospective drug utilization review

• record-keeping requirements

• a requirement to offer counsel

OBRA ‘90 specific components

• drug hame

• intended use/action

• route, dosage form, dosage, administration schedule

• common side/adverse effects

• interactions/contraindications

• proper storage

• refill information

• action in the event of missed dose

Arkansas subpart 29

• face-to-face counseling is required for new prescriptions

• alternative forms may be used to supplement, but should not replace

• counseling is required for outpatients of hospitals when medications are dispensed on discharge

Arkansas OBRA ‘90 plus additional components

• significant interactions with OTC drugs

• significantly affected by food or diet

• inform patient/caregiver that pharmacist is available to answer questions

Arkansas subpart 29 on refils

the pharmacist shall present the opportunity for the patient to ask questions

3 prime questions

1. what did you doctor tell you the medication is for?

2. how did your doctor tell you to take the medication?

3. what did your doctor tell you to expect?

Teach-back

method to ensure the patient understands the education you just provided; allows for one last opportunity to emphasize important points or correct miscommunications

Modified prime questions for refills

1. what do you take this medication for?

2. how do you take this medication?

3. what problems are you experiencing with this medication?/how is this medication work for you?

Social threat

our brains don’t distinguish well between physical and social threat; embarrassment and judgement can be perceived as threats

Eliciting concerns in MI

• allows intervention to be targeted to particular concerns

• avoid assuming you know reasons for non-adherence

• what do they already know?

• simple open-ended questions

Reflect in MI

• verbally reflect the core concern and line of reasoning

• give them a chance to correct you

• include empathy

• look for positive in their concern

Eliciting more information in MI

• assess understanding of drug/disease state

• understanding benefits of drug and consequences of not taking it is necessary for adherence

Knowledge gaps

• underestimating risks of untreated disease

• overestimating risks of adverse effects

• not knowing complications of disease

Providing information - 3 things

1. ask permission

2. keep delivery simple, targeted to needs (from elicit step), and in reasonable doses

3. invite the patient to draw conclusion

Change talk

statements indicating that a patient is…

• thinking about what you’ve said

• changing their own thinking/reasoning