Advertisement

International Journal of Clinical Pharmacy

, Volume 33, Issue 3, pp 529–536 | Cite as

Exploring communications around medication review in community pharmacy

  • Susanne KaaeEmail author
  • Ellen Westh Sørensen
  • Lotte Stig Nørgaard
Research Article

Abstract

Objectives Investigation into aspects that influence outcomes of medication reviews have been called for. The aim of this study was to assess how pharmacy internship students in a Danish medication review and reconciliation model communicated with both diabetes patients and the patients’ General Practitioners (GPs) when conveying the results of the review by writing letters to the different parties. Special attention was drawn to how differences in health care provider and patient perspectives of the disease as well as inclusion of the patient in the decision making process is influenced by the identified practices of communication. Setting 18 Danish community pharmacies with The Department of Pharmacology and Pharmacotherapy at the Faculty of Pharmaceutical Sciences, University of Copenhagen. Method Number of identified drug related problems, life-world problems and solutions to these described in the letters sent to patients and their GPs were registered. Further a qualitative documentary analysis was conducted by analyzing the letters using the theory of transactional analysis, developed by Berne. Main outcome measures Identified and conveyed drug related and life-world related problems when comparing patients’ letters with GPs’ letters. Whether students assumed a superior, inferior or equal role in relation to the recipient of the letter and compared whether students assumed the same role in relation to patients and GPs. Results 18 pairs of patient and GP letters were analyzed. The analysis showed that students conveyed more drug-related problems to GPs than to patients. Furthermore, students assumed an equal relationship to GPs, whereas they frequently took superior positions when writing to patients. Students reported lifestyle problems both to GPs and to patients. Conclusion Pharmacy students in a Danish medication review and reconciliation model managed to detect and address lifestyle problems of patients to their GPs, thereby facilitating the merger of their professionaltechnical perspective with the life-world perspective of patients. However, patients were not encouraged to become more involved in the disease management process.

Keywords

Collaborative relationships Decision making Denmark Diabetes type 2 Lifeworld Medication review 

Notes

Funding

The study was in part funded by the Compliance Fund of 2007; The Danish Ministry of the Interior and Health.

Conflicts of interest

None declared.

References

  1. 1.
    Krass I, Smith C. Impact of medication regimen reviews performed by community pharmacists for ambulatory patients through liaison with general practitioners. Int J Pharm Prac. 2000;8:111–20.CrossRefGoogle Scholar
  2. 2.
    Krass I, Taylor SJ, Smith C, Armour CL. Impact of medication use and adherence of Australian pharmacists’ diabetes care services. J Am Pharm Assoc (Wash). 2005;45:33–40.Google Scholar
  3. 3.
    Sorensen L, Stokes JA, Purdie DM, Woodward M, Elliott R, Roberts MS. Medication reviews in the community: results of a randomized, controlled effectiveness trial. Br J Clin Pharmacol. 2004;58(6):648–64.PubMedCrossRefGoogle Scholar
  4. 4.
    Zermansky AG, Petty DR, Raynor DK, Freemantle N, Vail A, Lowe CJ. Randomised controlled trial of clinical medication review by a pharmacist of elderly patients receiving repeat prescriptions in general practice. Br Med J. 2001;323:1–5.CrossRefGoogle Scholar
  5. 5.
    Zermansky AG, Freemantle N. Is medication review by pharmacists of any use? Pharmacoeconomics. 2007;25(2):91–2.PubMedCrossRefGoogle Scholar
  6. 6.
    Armour CL, Taylor SJ, Hourihan F, Smith C, Krass I. Implementation and evaluation of Australian pharmacists’ diabetes care service. J Am Pharm Assoc (Wash). 2004;44:455–66.Google Scholar
  7. 7.
    Cranor CL, Christensen DB. The Asheville project: short-term outcomes of a community pharmacy diabetes care program. J Am Pharm Assoc (Wash). 2003;43(2):149–59.CrossRefGoogle Scholar
  8. 8.
    Cranor CL, Bunting BA, Christensen DB. The Asheville project: long-term clinical and economic outcomes of a community pharmacy diabetes care program. J Am Pharm Assoc (Wash). 2003;43(2):173–84.CrossRefGoogle Scholar
  9. 9.
    Wermeille J, Bennie M, Brown I, McKnight J. Pharmaceutical care model for patients with type 2 diabetes: integration of the community pharmacist into the diabetes team—a pilot study. Pharm World Sci. 2004;26:18–25.PubMedCrossRefGoogle Scholar
  10. 10.
    Chen TF, de Almeida Neto AC. Exploring elements of interprofessional collaboration between pharmacists and phycisians in medication review. Pharm World Sci. 2007;29:574–6.PubMedCrossRefGoogle Scholar
  11. 11.
    Loewe R, Freeman J. Interpreting diabetes mellitus: differences between patient and provider models of disease and their implications for clinical practice. Cult Med Psychiatry. 2000;24:379–401.PubMedCrossRefGoogle Scholar
  12. 12.
    Hunt LM, Arar NH. An analytical framework for contrasting patient and provider views of the process of chronic disease management. Med Anthropol Q. 2001;15(3):347–67.PubMedCrossRefGoogle Scholar
  13. 13.
    Wiuff MB, Jacobsen CB, Sørensen TH, Nielsen ML. Intensiv polyfarmakologisk behandling af patienter med type 2-diabetes i daglig klinisk praksis. København: Sundhedsstyrelsen, Enhed for Medicinsk Teknologivurdering; 2007.Google Scholar
  14. 14.
    Heisler M, Bouknight RR, Hayward RA, Smith DM, Kerr EA. The relative importance of physician communication: participatory decision making, and the patient understanding in diabetes self-management. J Gen Intern Med. 2002;17:243–52.PubMedCrossRefGoogle Scholar
  15. 15.
    Jahng KH, Martin LR, Golin CE, DiMatteo R. Preferences for medical collaboration: patient-physician congruence and patient outcomes. Patient Educ Couns. 2005;57:308–14.PubMedCrossRefGoogle Scholar
  16. 16.
    Roach P, Marrero D. A critical dialogue: communicating with type 2 diabetes patients about cardiovascular risk. Vasc Health Risk Manag. 2005;1(4):301–7.PubMedCrossRefGoogle Scholar
  17. 17.
    Stevenson FA, Cox K, Britten N, Dundar Y. A systematic review of the research on communication between patients and health care professionals about medicines: the consequences for concordance. Health Expect. 2004;7:235–45.PubMedCrossRefGoogle Scholar
  18. 18.
    Haidet P, Kroll TL, Sharf BF. The complexity of patient participation: lessons learned from patients’ illness narratives. Patient Educ Couns. 2006;62:323–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Golin CE, DiMatteo MR, Leaks B, Duan N, Gelberg L. A diabetes-specific measure of patient desire to participate in medical decision making. Diabetes Educ. 2001;27(6):875–86.PubMedCrossRefGoogle Scholar
  20. 20.
    Golin CE, DiMatteo MR, Duan N, Leaks B, Gelberg L. Impoverished diabetic patients whose doctors facilitate their participation in medical decision making are more satisfied with their care. J Gen Intern Med. 2002;17:866–75.CrossRefGoogle Scholar
  21. 21.
    Doucette WR, Nevins J, McDonough RP. Factors affecting collaborative care between pharmacists and physicians. Res Social Adm Pharm. 2005;1:565–78.PubMedGoogle Scholar
  22. 22.
    Zillich AJ, McDonough RP, Carter BL, Doucette WR. Influential characteristics of physician/pharmacist collaborative relationships. Ann Pharmacother. 2004;38:764–70.PubMedCrossRefGoogle Scholar
  23. 23.
    McDonough RP, Doucette WR. Developing collaborative working relationships between pharmacists and physicians. J Am Pharm Assoc (Wash). 2001;41(5):682–92.Google Scholar
  24. 24.
    Thornquist E. Klinik, kommunikation, information [Clinic, communication, information]. Copenhagen: Hans Reitzels Forlag a/s; 2000.Google Scholar
  25. 25.
    Chen TF, Moles R, Nishtala P, Basger B. Case studies in practice. Medication review: a process guide for pharmacists. 2nd ed. Pharmaceutical Society of Australia 2010; ISBN: 978-0-646-52420-7.Google Scholar
  26. 26.
    Berne E. Intuition and ego states. 1st ed. San Fransisco: TA Press; 1977. ISBN: 0-89489-001-8.Google Scholar
  27. 27.
    Lützen P. Sproglig analyse og relevans [Linguistic analysis and relevance]. 1st ed. Dansklærerforeningen; 2004 ISBN: 87-7996-025-1.Google Scholar
  28. 28.
    Lauvås K, Lauvås P. Tværfagligt samarbejde: perspectiv og strategi [Professional collaboration: perspective and strategy]. Århus: Klim; 2006. ISBN: 87-7955-463-6.Google Scholar
  29. 29.
    Vinter-Repalust N, Petricek G, Katic M. Obstacles which patients with type 2 diabetes meet adhering to the therapeutic regimen in everyday life: qualitative study. Croat Med J. 2004;45(5):630–6.PubMedGoogle Scholar
  30. 30.
    Kumagai AK, Murphy EA, Ross PT. Diabetes stories: use of patient narratives of diabetes to teach patient-centered care. Adv Health Sci Educ Theory Pract. 2008;14:315–26.PubMedCrossRefGoogle Scholar
  31. 31.
    Fhärm E, Rolandsson O, Johansson EE. Aiming for the stars’—GPs’ dilemmas in the prevention of cardiovascular disease in type 2 diabetes patients: focus groups interviews. Fam Pract. 2009;26:109–14.PubMedCrossRefGoogle Scholar
  32. 32.
    Wens J, Vermeire E, Royen PV, Sabbe B, Denekens J. GPs’ perspectives of type 2 diabetes patients’ adherence to treatment: a qualitative analysis of barriers and solutions. BMC Family Practice. 2005;6(20).Google Scholar
  33. 33.
    Cooper RJ, Bissell P, Wingfield J. ‘Islands and doctor’s tool’: the ethical significance of isolation and subordination in UK community pharmacy. Health (NY). 2009;13:297–316.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2011

Authors and Affiliations

  • Susanne Kaae
    • 1
    Email author
  • Ellen Westh Sørensen
    • 1
  • Lotte Stig Nørgaard
    • 1
  1. 1.The Department of Pharmacology and Pharmacotherapy, Section for Social Pharmacy, The Faculty of Pharmaceutical SciencesUniversity of CopenhagenKøbenhavn ØDenmark

Personalised recommendations