Thoroughness of community pharmacists' assessment and communication using the patient care process

Background: The patient care process (PCP) was adopted to move community pharmacy practice from the traditional dispensing role to a more professional level of patient care. However, research has not yet empirically characterized how pharmacists conduct the PCP in community pharmacies.

Objectives: This study characterizes how pharmacists employ the PCP when evaluating medication appropriateness in a simulated community pharmacy setting.

Methods: A mixed methods analysis was employed to analyze simulated patient-pharmacist interactions (i.e., consultations), and concurrent think-aloud (checking sessions). Transcripts were quantitatively coded for elements of the PCP. A generic qualitative approach was used to explore how pharmacists provided care.

Results: Almost all pharmacists checked for medication indication, safety, and manageability at the end of the process when releasing the medication to the patient. Still, most pharmacists gathered insufficient information to fully evaluate medication appropriateness. Six overarching themes described consultations and checking sessions: missed opportunities, the absence of personalized assessments, reliance on routines, nonspecific questions, communication style, and response to patient cues. The quantitative and qualitative findings together created a picture of incomplete assessments which were driven by technical routines and medication-focused communication.

Conclusion: Overall, the majority of pharmacists completed most of the patient-care process. Even so, pharmacists did not complete a full assessment of medication appropriateness. Patient care tasks were driven by routines and occurred at the end of the process, whereas the initial patient assessment and prescription check were mainly devoted to technical activities. Pharmacists had opportunities to enhance patient-centered communication by engaging patients in dialogue and recognizing patient emotional cue.