Ashley Saclolo, MS

Pharmacy technicians (techs) are frequently the first point of contact when patients pick up their prescriptions or purchase OTC medications.

Techs also interact with caregivers, health plans, employees from prescribers’ offices, and other stake holders in the medication-use process. Thus, effective communication is among the most important skills for techs, yet one that is often overlooked.

Patients may visit the pharmacy with many questions about their medications and other issues related to their health conditions. At the same time, they may be frustrated at having to navigate the complex health care system.

Techs must assuage patients’ concerns and frustrations and determine which issues should be attended to by the pharmacist. Using effective communication strategies, such as motivational interviewing (MI), can help mitigate patients’ anxiety and elicit the information needed for proper referral. It may also help to convey the message that pharmacists care.

MI is a collaborative, patient-centric communication style that helps patients explore their ambivalence and reflect on their choices to promote changes in behavior.

 The goal is for patients to be motivated to make changes or take a difference stance on an issue, as opposed to simply accepting something or having it forced upon them.

Traditional conversations between a health care provider and patient are more authoritative, emphasizing the transfer of information and expectation of outcome, rather than exploring ambivalence. For example, rather than tell a patient they must quit smoking or face the consequences, then rattle off a list of deleterious outcomes associated with the habit, a tech using MI principles would employ empathy and ask the patient to reflect on why quitting might be helpful for them and their loved ones.

MI encourages patients to take an active role in making healthy lifestyle choices on their own. The technique is composed of 4 key elements, known as the spirit of MI: collaboration, acceptance, compassion, and evocation.

Collaboration between patient and tech is the first element. The tech can initiate this during the first interaction, asking open-ended questions to ascertainwhat the patient needs.

Enabling patients to feel in control during their conversations empowers them. They are much more likely to share information and allow the tech to get to the root of the problem or identify barriers through honesty, openness, and self-reflection. Collaboration is accompanied by a nonjudgmental tone, with no attempts to chide or scold the patient.

During the second element of MI, acceptance, the tech recognizes and acknowledges the positive efforts of the patient’s actions. This indicates respect for the patient’s preferences and values.

For example, if a patient who was previously nonadherent confides that they have changed their evening routine to better incorporate bedtime medi- cations and achieved some level of success, the tech would acknowledge that improvement rather than demand the patient do even better. This does not mean the tech accepts suboptimal adherence, but that they recognize the positive changes the patient has made. The tech can then explore options to further improve adherence, on the patient’s terms.

Compassion is the third element. Actively listening and being present in the conversation demonstrates to the patient that the tech is fully committed to helping. The fourth element of the MI spirit is evocation. By evoking the patient’s motivation to change a behavior, for example, the tech can help them move from ambivalence to action and help them to sustain that change. Techs can do this through reflecting and summarizing for the patient the planned behavior change.

In addition to the 4 key elements, the following 5 principles help guide one’s actions while conducting MI. These can be summarized by the READS acronym

Reframe and reflect but do not actively confront patients with their resistance to behavior change. Explore with them the negative and positive consequences of not changing their behavior.

Real empathy is required in this case. For example, if you told a friend you were in a car accident yesterday but did not sustain major injuries, they would not first ask whether you had been speeding or whose fault it was. Neither would they say that everything will be fine or talk about their own accident a few months earlier. None of these comments would make you feel better.

This is easier when asking questions rather than making declarative statements. Techs should also avoid questions that are condescending or leading.

Help patients come to their own realization of the discrepancy that exists between their behaviors and goals.

Inspire patients with confidence that they can make changes.

MI is one of many techniques that techs can apply when interacting with patients, even if it is the pharmacist who ultimately undertakes the main behavior-change counseling. By asking open-ended questions, demonstrating empathy, and exploring ambivalence, techs can get better results from various communication encounters, including medication histories.

Additionally, techs can create a better sense of teamwork among their peers by employing MI, helping them to realize the value of each person’s contribution to the organization.

In other situations, such as when speaking with individuals from health insurance companies or physician offices, using MI concepts can enable techs to avoid turf battles, make the other person aware that their behaviors or views might not be in the patient’s best interests, and focus the discussion on the most important issues. Continuing education and other resources on MI can help techs to employ this effective and selfless communication practice.

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Articles

This overlooked skill can help determine which issues should be passed on to the pharmacist.
 

Motivational Interviewing: Effective Communication Is Vital

Many patients are under the false assumption that there are no risks, adverse effects (AEs), contraindication, or potential drug interactions posed by taking OTC medications. This stems from their easy access, relatively affordable cost, and use for self-treatable symptoms.

Unfortunately, OTC accessibility and the lack of guidance from a prescriber for their use coupled with these false assumptions can often lead to misuse and even abuse of these medications. However, most OTC medications were once available as prescription-only, although usually in higher strengths, and thus pose a threat for AEs given their mechanisms of action.

Although some OTCs are sold in a variety of retail outlets, most sales occur in community pharmacies. Given the ubiquity of OTC use and a greater emphasis by patients on self-treatment, one of the more important roles of pharmacy personnel is to ensure their safe and effective use. To ameliorate the potential for abuse and addiction with OTC drugs, pharmacists rely heavily on pharmacy technicians to recognize a potential problem during their initial interactions with patients who present to the pharmacy. 

Pharmacy technicians are the persons that most patients first encounter when purchasing OTC medications or even browsing the aisles. Although technicians are already juggling myriad job responsibilities, they may be encouraged to peruse the OTC medications section to offer assistance to patients.

These patients are often confused by brand and generic names, particularly with the labeling often used for these products, with tags such as “new formulation,” “only product with [ingredient name]”, along with nighttime and daytime formulations, extra strength, extended relief, and so on. For example, patients likely have very little idea that among cough and cold remedies, there are only a handful of active ingredients in various combinations and quantities that compose the entire array of the hundreds of products available.

Without knowledge of advanced pharmacology, technicians know enough to point out facts such as this. This will not only make patients better users of OTC medications, but likely engender greater trust and loyalty to the pharmacy. There is nothing to suggest that good business practices and effective patient care don’t mix.

Of course, there are other issues that transcend merely optimal use and patients’ simpler questions. Technicians must be educated and trained on when to involve the pharmacist and referring patients to pharmacists even further ensures trust and optimal medication use.

This is particularly the case for issues around proper dosing and potential interactions, which are even more salient for patients who are pregnant, pediatric patients, and those with compromised renal function or immune systems, as even certain OTCs can be problematic for these patients. The important thing is that technicians can serve as an effective liaison between the patient and the pharmacist.

The better that technicians are made aware of how to serve in this capacity, the better they will be at performing these jobs. Some basic knowledge of drug names and ingredients is helpful, but so are communication and triaging skills.

Technicians should become aware of the most commonly abused OTC drugs. These include certain antihistamines, cough medicines, analgesics, laxatives, and decongestants, with analgesics such as ibuprofen and acetaminophen being the most frequently misused drugs.

For example, 1 in 4 patients would exceed the recommended dose of acetaminophen by taking 1 or more OTC products containing it as the active ingredient and thus overdosing.

 Technicians can exercise vigilance when selling OTC drugs in these categories to reduce inappropriate use and informing the pharmacist when a patient purchases 2 medications with the same active ingredient. This is where the technician’s basic knowledge of OTC drugs comes in handy.

Additional methods technicians can address general indicators of OTC misuse and abuse is by being aware of patients who purchase unusually large quantities of a product and taking note of how frequently a patient may come in to purchase the same drug.

 Technicians can keep track of OTC purchases in their patient profiles and bring to the attention of the pharmacist any red flags that may stir caution and oversight.

This raises the issue of documentation and is among the important value-added responsibilities that effective technicians can bring to the table. Although prescription medications inherently become part of the patient’s medication record, it is important for technicians to document patients’ use of OTCs.

Some of this information might become important data in prescription drug monitoring programs (PDMPs). This is not always easy, as OTC purchases might be completed at the front register or might take place during very harried times at the prescription counter.

However, every bit of documentation can help to optimize medication use. And knowing that patients may make OTC purchases elsewhere further underscores the need for effective medication-history taking and use of open-ended questioning by technicians while engaging patients.  

Pharmacy technicians can play an important role in safe and effective use of OTCs by patients. It requires their basic knowledge of drug products, coupled with skills in communication and knowledge of law and ethics, along with effective delegation and training by their pharmacist supervisors.

, is PharmD Candidate at Touro University California College of Pharmacy.

, is professor of Social/Behavioral Pharmacy at Touro University California College of Pharmacy.

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Many patients are under the false assumption that there are no risks or potential drug interactions posed by taking OTC medications.