Exploring community pharmacists consultation skills

Janet Krska, Shivaun Gammie, Julian Childs

medway school of pharmacy

Pharmacy Practice Research Group

Why are we doing this project?

Pharmacist consultations are not always in line with what patients may expect or need. There is little training available to help pharmacists develop their consultation skills. Patients views on their experiences of consultations with pharmacists have not been well researched.

medway school of pharmacy

Pharmacy Practice Research Group

When do pharmacists consult?

Pharmacists provide two nationally commissioned services which involve consultations in private:
Medicines Use Reviews (MURs) which aim to help patients understand their medicines and identify any problems they are experiencing, along with possible solutions.

New Medicines Service (NMS) which aims to help patients manage newly prescribed medicines for a long term condition.
medway school of pharmacy
Pharmacy Practice Research Group

Assessment using the MedicationRelated Consultation Framework MRCF

How well did the practitioner undertake the following activities when consulting with the patient?

A. B. C. D. E.

Introduction Data collection and problem identification Actions and solutions Closing Consultation behaviours

Covers 29 specific items

Each graded from 0 (did not) to 4 (fully)

Overall impression:

Not competent Poor

Not competent Borderline

Competent Satisfactory

Competent Good

Competent Very good

medway school of pharmacy

Pharmacy Practice Research Group

Two-stage project
Stage 1
Explore what happens during consultations Use what we learn to develop a way of assessing and improving consultations through feedback to the pharmacist

Stage 2
Test whether the assessment and feedback package improves consultation skills
medway school of pharmacy
Pharmacy Practice Research Group

Stage 1: Methods and responses

5 pharmacists recruited patients eligible to receive the NMS.

13 face-to-face consultations were directly observed and assessed by one of two tutors, using the MRCF. Each pharmacist received personalised feedback from the tutor on how they performed in their observed consultations.
Semi-structured interviews were conducted with:
11 patients who gave consent All 5 pharmacists after they had received feedback Tutors after providing feedback to each individual pharmacist (n=5)

medway school of pharmacy

Pharmacy Practice Research Group

So what did we find?

Four major themes: Quality of consultations Impact on patient behaviour Importance of feedback MRCF and consultation behaviours

medway school of pharmacy

Pharmacy Practice Research Group

Quality of consultations
I think she conducted them very well.
(Tutor 1 on Pharmacist 5)

He obviously knew what he was talking about, well-equipped to do that sort of thing interview wise.
(Patient 2)

Most comments were positive

I feel quite comfortable doing these things, I dont have an issue with them.
(Pharmacist 1)

Consultations were perceived as useful but limited in scope [The pharmacist] virtually repeated what the doctor had told me. (Patient 7)
Having read the information on how to use it there wasnt a lot left for the pharmacist to really to do. (Patient 5)

There was one comment from a ladyshe felt it was a good idea doing this because it's useful to come to speak to somebody else other than the GP. (Tutor 1 on Pharmacist 4)

Impact on patient behaviour

I took them religiously, didnt matter what happened I always took them, so it didnt make any difference to me. (Patient 10)
I think it made them think more about why they are taking them and possible side effects.
(Pharmacist 4)

I think it was worthwhile because the attitude to the patient and the pharmacist to make the patient feel that, yes, he should take his medication. The pharmacist reinforced he should take his medication.
(Tutor 1 on Pharmacist 2)

Most patients were adherent

Consultations improved attitudes towards taking medicines in some patients

[The pharmacist] gave me some more information about the medicine and so you know I'm feeling better with that than before. (Patient 1)

It is a bit overpowering when you all of a suddenits practically a change in lifestyle because now my day is organised around taking medicine and various foods etc., so yeah help with that but nothingsupportnot just the technical, but the encouragement. (Patient 4)

Importance of feedback
you dont sort of get together with other pharmacists and say oh how do you do it so much, do you? So I dont really know how well my consultation skills are compared to somebody else.
(Pharmacist 5)

when you're talking to the patients you sometimes forget what you should have said. (Pharmacist 2)
The consultation began with a closed question which I felt then cut off the patient actually discussing the medication: it was yes, no, nodding responses.
(Tutor 2 on Pharmacist 1)

A valuable learning experience Most pharmacists didnt set out an agenda for the consultation, in particular a shared agenda.
I felt that if [the pharmacist] did introduce [the consultation] and explain the nature of it I think it might have been a good way of keeping it on track. (Tutor 2 on Pharmacist 3)

I thought the first patient went off at a tangent but I couldnt quite control him.
(Pharmacist 1)

Indicators of good consultations

Empathy demonstrated Open questions used Information gathering noted Avoided or explained jargon Checked patient comprehension Follow-up consultations arranged (13/13) (12/13) (12/13) (13/13) (10/13) (9/13)

medway school of pharmacy

Pharmacy Practice Research Group

Usefulness of the MRCF

Need for additional areas?: side effects, over the counter medicines Areas covered in MRCF may not fit with the New Medicine Service Longstanding relationships facilitate a relaxed atmosphere, but mean some aspects of MRCF are not applicable
The guidance for the New Medicine Service is, is a set format and I think thats what pharmacists are following. To transpose that onto this framework, onto the Medicine Related Consultation Framework, is it takes a little bit of getting used to.
(Tutor 2 on Pharmacist 3)

So for me to say oh hi I'm or whatever; I did welcome them in by calling them with their names but they know me anyway, so I didnt see the need to introduce myself.
(Pharmacist 3)

medway school of pharmacy

Pharmacy Practice Research Group

Limitations
All pharmacists were self-selected and may be atypical The NMS consultations observed all involved patients who were adherent to their medicines and willing to participate (cant generalise) One pharmacist only conducted one observed consultation therefore feedback likely to be less helpful
medway school of pharmacy
Pharmacy Practice Research Group

Future use of MRCF?

Is it easily applicable to community pharmacists? (need observer) Potential for video recording of consultations (used by GPs) Benefits of personalised feedback to community pharmacists Benefit of seeking patient feedback on consultation style
medway school of pharmacy
Pharmacy Practice Research Group

Stage 2 just starting

Pharmacists in four areas (Bexley, Bromley, Greenwich, Lewisham) invited to participate.

Pharmacists can either: a) complete the Kings College Diabetes training package, then have their consultation skills assessed by a tutor b) join a comparator group of pharmacists who do not receive training.
Group a) pharmacists will complete questionnaires about consultation skills at baseline and after receiving feedback. Group b) pharmacists will complete only the baseline questionnaire. Both groups will be asked to distribute questionnaires to patients who have received consultations, for either NMS or MUR. medway school of pharmacy
Pharmacy Practice Research Group

For more information

Professor Janet Krska
01634 202950 j.krska@kent.ac.uk

Dr Shivaun Gammie
01634 202945 s.m.gammie@kent.ac.uk

medway school of pharmacy

Pharmacy Practice Research Group

Acknowledgements
Dr Julian Childs was responsible for all aspects of this study, including conducting and analysing interviews Susan Ritchie and Maureen Mannion, our two pharmacist tutors All the five community pharmacists who were willing to take part and recruit their patients The patients who took part South London HIEC for funding
medway school of pharmacy
Pharmacy Practice Research Group