Pharmacist-patient medication communication during admission and discharge in specialty hospital settings: implications for person centered healthcare
Keywords:Communication, health care, acute / critical, medication, observation, participant, research, qualitative
AbstractBackground Hospital admission and discharge are critical transition points for patients’ medication management. Effective communication between pharmacists and patients at these transition points has the potential to mitigate medication incidents. Previous research has examined communication among community pharmacists and patients. Limited research has explored the complexities of communication between hospital pharmacists and patients during admission and discharge interactions.Objective To explore the complexities of pharmacist-patient medication communication during medication admission and discharge in specialty hospital settings.Methods The study was conducted at a metropolitan Australian public hospital. An exploratory qualitative design was used involving the methods of semi-structured interviews and participant observation. Interviews and observations were undertaken in five specialty settings: cardiothoracic care, intensive care, emergency care, oncology care and perioperative care. A comprehensive thematic analysis of the data was performed.Results Twelve pharmacists and 69 patients participated in interviews and observations for the study. Over 200 hours of observational data were collected. In total, 26 medication admissions and 35 medication discharges were observed. Pharmacists regulated communication with patients by using structured communication tools. When providing or gathering information, pharmacists controlled the level of patient engagement. Words used in pharmacist-patient communication were sometimes ambiguous and occasionally miscommunication resulted. Patients sought minimal information from pharmacists.Conclusions Pharmacists need to apply patient-centered principles, and encourage active patient involvement, in admission and discharge conversations.
. Spinewine, A., Claeys, C., Foulon, V., Chevalier, P. (2013). Approaches for improving continuity of care in medication management: a systematic review. International Journal for Quality in Health Care 25:403-417.
. Vira, T., Colquhoun, M., Etchells, E. (2006). Reconcilable differences: correcting medication errors at hospital admission and discharge. Quality & Safety in Health Care 15:122-126.
. Tam, V.C., Knowles, S.R., Cornish, P.L., Fine, N., Marchesano, R., Etchells, E.E. (2005). Frequency, type and clinical importance of medication history errors at admission to hospital: a systematic review. Canadian Medical Association Journal 173:510-515.
. Department of Health. (2013) Quality Use of Medicines. Available at: http://www.health.vic.gov.au/qum/hrm.htm. (last accessed October 4 2013].
. Department of Health. (2012) Supporting patient safety. Sentinel event program annual report 2010-11. Available at: http://docs.health.vic.gov.au/docs/doc/F55ED6726B0250DECA257A690079AAFC/$FILE/AnnualReport010-11%5BBookmarkedweb version%5D.pdf. (last accessed October 4 2013].
. Nichols, P., Copeland, T., Craib, I., Hopkins, P., Bruce, D. (2008). Learning from error: identifying contributory causes of medication errors in an Australian hospital. The Medical Journal of Australia 188:276-279.
. Pilnick, A. (1999). Patient counseling by pharmacists. Sociological Quarterly 40:613-622.
. Bauman, A.E., Fardy, H.J., Harris, P.G. (2003). Getting it right: why bother with patient-centred care? Medical Journal of Australia 179:253-256.
. Murad, M.S., Chatterley, T., Guirguis, L.M. (2013). A meta-narrative review of recorded patient–pharmacist interactions: Exploring biomedical or patient-centered communication? Research in Social and Administrative Pharmacy: in press.
. Chewning, B., Sleath, B., L. (1996). Medication decision-making and management: A client centered model. Social Science & Medicine 42:389-398.
. de Oliveira, D., Brummel, A., Miller, D. (2010). Medication therapy management: 10 years of experience in a large integrated health care system. Journal of Managed Care Pharmacy 16:185-195.
. Hargie, O.D., Morrow, N.C., Woodman, C. (2000). Pharmacists’ evaluation of key communication skills in practice. Patient Education and Counseling 39:61-70.
. Shah, B.K., Chewning, B. (2011). Concordance between observer reports and patient survey reports of pharmacists’ communication behaviors. Research in Social and Administrative Pharmacy 7:272-280.
. LeBlanc, J., Dasta, J. (2005). Scope of international hospital pharmacy practice. Annals of Pharmacotherapy 39:183-191.
. Mueller, S., Sponsler, K., Schnipper, J. (2012). Hospital-based medication reconciliation practices: a systematic review. Archives of Internal Medicine 172:1057-1069.
. Vogelsmeier, A., Pepper, G.A., Oderda, L., Weir, C. (2013). Medication reconciliation: A qualitative analysis of clinicians' perceptions. Research in Social and Administrative Pharmacy 9:419-430.
. Babalola, O., Erhun, W. (2001). Pharmacist medication history interview of elderly patients in a teaching hospital in Nigeria. International Journal of Pharmacy Practice 9:97-103.
. Pilnick, A. (2003). "Patient counselling" by pharmacists: Four approaches to the delivery of counselling sequences and their interactional reception. Social Science & Medicine 56:835-849.
. Polit, D., Beck, C. (2006). Essentials of Nursing Research. 6th ed. Philadelphia: Lippincott Williams & Wilkins.
. Lincoln, Y., Guba, E. (1985). Naturalistic Inquiry. California: Sage Publications.
. Denzin, N. (1989). The Research Act: A Theoretical Introduction to Sociological Methods. Englewood Cliffs, New Jersey: Prentice Hall.
. Polit, D., Beck, C. (2010). Generalization in quantitative and qualitative research: Myths and strategies. International Journal of Nursing Studies 47:1451-1458.
. Ritchie, J., Spencer, L. (1994) Qualitative data analysis for applied policy research. In: Analyzing Qualitative Data (ed. Bryman, A., Burgess, R.G.). pp. 173-194. London: Routledge.
. Greenhill, N., Anderson, C., Avery, A., Pilnick, A. (2011). Analysis of pharmacist–patient communication using the Calgary-Cambridge guide. Patient Education and Counseling 83:423-431.
. Morecroft, C., Thornton, D., Caldwell, N. (2013). Inpatients' expectations and experiences of hospital pharmacy services: qualitative study. Health Expectations.
. Worley, M.M., Schommer, J.C., Brown, L.M., Hadsall, R.S., Ranelli, P.L., Stratton, T.P., Uden, D.L. (2007). Pharmacists' and patients' roles in the pharmacy-patient relationship: Are pharmacists and patients reading from the same script? Research in Social and Administrative Pharmacy 3:47-69.
. Dutton, K., Hedger, N., Wills, S., Brown, D., Davies, P. (2003). Prevent medication errors on admission. Clinical Governance: An International Journal 8:128-137.
. Hume, A., Kirwin, J., Bieber, H., et al. (2012). Improving care transitions: Current practice and future opportunities for pharmacists. Pharmacotherapy 32:e326-e337.
. Nair, K., Dolovich, L., Cassels, A., McCormack, J., Levine, M., Gray, J., Mann, K., Burns, S. (2002). What patients want to know about their medications. Focus group study of patient and clinician perspectives. Canadian Family Physician 48:104-110.
. Gallagher, R.M., Gallagher, H.C. (2012). Improving the working relationship between doctors and pharmacists: Is inter-professional education the answer? Advances in Health Sciences Education 17:247-257.
. Freeman, G.K., Horder, J.P., Howie, J.G.R., Hungin, A.P., Hill, A.P., Shah, N.C., Wilson, A. (2002). Evolving general practice consultation in Britain: issues of length and context. British Medical Journal 324:880-882.