The involvement of pharmacists in nonprescription medication counseling will increase the public's ability to understand the risks and benefits of OTC remedies. It has been well documented that interactions by pharmacists through consultation and effective assessment strategies can enhance patient outcomes. In order to counsel patients efficiently, pharmacists must be able to communicate.
One way to ensure understanding is through active listening, a process in which the receiver repeats the information back to the sender. This process fosters information exchange and promotes effective learning. The first step in achieving optimal communication is setting the stage. By identifying potential barriers in the pharmacy that can impede good communication, pharmacists can actively take steps to overcome them. It is important to remove distractions or barriers that may affect interactions with patients.
Potential Barriers to Patient Consultation
Several barriers exist in a community pharmacy environment. The 3 most common are barriers from the pharmacy environment, barriers arising from the pharmacist, and barriers stemming from the patient.
The design of a pharmacy has a major impact on how patients view pharmacists and react to their consultation efforts. Environmental barriers present a challenge for all pharmacist?patient interactions. For example, the presence of a high counter prevents easy eye contact and makes a pharmacist seem aloof and even uncaring. The lack of semiprivate space deters patients from asking questions of their pharmacist or describing problems.
To overcome these types of environmental and physical barriers, the pharmacist should come out from behind the dispensing area to consult with patients and communicate face to face. By sitting or standing at eye level or lower, the pharmacist does not seem threatening, and that stance opens lines of communication.1 If it is not possible for the pharmacist to come out from behind the counter, he or she should attempt to minimize the barrier produced by the counter by focusing on the patient.
Other barriers also can impede pharmacist?patient communication. Such barriers include inappropriate use of interpersonal space by the pharmacist, inappropriate body language, or inappropriate vocal characteristics. Corrective actions for these kinds of barriers can be remembered by Muldary's acronym, "CLOSER" (Table 1).2
Patients also can create barriers that pharmacists must recognize. Functional barriers hinder the patient's ability to understand information that is being communicated by the pharmacist. Examples of functional barriers are listed in Table 2.
Sensory deficits include blindness, deafness, or other visual impairments. Whereas some barriers are easily recognized through common sense, environmental barriers that are of relevance only to some individuals may not be obvious. For example, patients with poor vision may have difficulty reading OTC labels. During patient consultation, the pharmacist should assess how the pharmacy environment affects communication with the patient and take steps to minimize any barriers when possible.
In addition, language differences can be a frustrating barrier when counseling a patient about an OTC agent. Typically, children will accompany an older member of the family, and they can be used to help translate. In addition, bilingual police officers may be available in some areas to help. Providing written sheets along with verbal communication may help facilitate communication. Also, using pictures may be beneficial.
Functional illiteracy and low health literacy affect counseling about nonprescription agents. Patients who are functionally illiterate are difficult to identify because they often try to hide their inability to read or write. Patients with low health literacy have difficulty understanding disease-related information, medication information, and directions. These types of problems can lead to medication errors and worsen patient outcomes.
Comprehension difficulties can arise from dementia, psychiatric conditions, or mental retardation. Whatever the cause, the patient's inability to understand medication instructions may be difficult to overcome. Having a caregiver present can help with communication.
A patient's alternative health beliefs and personal health beliefs also can be functional barriers. Patients who have a different set of beliefs from Western medicine can be difficult to identify. Some signals that may alert pharmacists to this barrier include poor adherence and persistent questioning about an effect of a medicine.
Several books have been written about cultural differences in health care. This subject requires sensitivity on the part of the pharmacist. If possible, pharmacists should educate themselves about the beliefs of the people in the cultures they serve. This information can be used to avoid negative interactions and help support the communication pharmacists will have with patients.
In addition to Muldary's acronym, other techniques can be utilized to facilitate understanding and open lines of communication between pharmacists and patients.
Pharmacists should keep the following tips in mind:
- Be an active listener
- Use clear, unambiguous language appropriate to the knowledge of the patient
- Be cognizant of nonverbal cues
- Ask for feedback so as to clarify any misunderstandings
- Provide feedback, outlining the message
Some common barriers to active listening are multitasking, selectively listening to the patient, having internal monologue or planning one's next point while the patient is speaking, leaping ahead to make a conclusion, listening with one's ears only, or being too quick to jump in. Pharmacists need to recognize these obstacles to nonprescription counseling and take steps to overcome them.
Pharmacists are the nonprescription medication experts. Patients recognize this fact and typically use pharmacists as first-line sources of drug information. In order for pharmacists to nurture the relationships they have with patients, they must set the stage for optimal communication by using active listening, minimizing environmental barriers, eliminating pharmacist barriers, and overcoming patient barriers that may make counseling more difficult.
Dr. Ferreri is a clinical assistant professor at the University of South Carolina School of Pharmacy.
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