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P1 Pharmacy Practice > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

Sixth Man on the Team

A

Patient, Family & Caregivers

very valuable and contributing partners

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2
Q

What is SBAR?

A

communicating critical information that requires immediate attention and action concerning a patient’s condition
follows logical order to aid in clear and concise communication

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3
Q

Key to strengthening health systems:

A

moving them from fragmentation to collaborating to improve outcomes for pts

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4
Q

What does SBAR acronym stand for?

A

Situation – what is going on?
Background – What is the clinical background?
Assessment – What do you think the problem is?
Recommendation – What would you do?

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5
Q

inform team of critical information simultaneously

A

call out

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6
Q

Situational Awareness includes:

A

situation monitoring

cross monitoring

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7
Q

What is TeamSTEPPS designed to do

A

improve pt safety
increase quality and efficiency of care
improve communication and teamwork skills among healthcare professionals

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8
Q

Essential Elements

A 
team structure
strong leadership
situational awareness
mutual support
shared mental model
communication
"sixth man on the team"
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9
Q

Communication

A 
call out
check back
handoff
briefs
huddles
debriefs
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10
Q

Communication Techniques

A

simple language
handing out printed materials
speak slow
read aloud instructions
write out instructions
present 2 or 3 concepts at a time & check for understand
asking pt how they will follow instructions at home

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11
Q

Task Assistance is part of _______ and means ______

A

A part of mutual support and it is the protection from work overload
assistance will be actively sought and offered

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12
Q

initial plan and establish goals

A

briefs

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13
Q

Situational monitoring

A

active process

ask question, listen, notice

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14
Q

TEAM STEPPS stands for:

A

TEAM Strategies and Tools to Enhance Performance and Patient Safety

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15
Q

Effective Team Leaders:

A

organize
articulate clear goals
make decisions –through collective input of members
empower members–to speak up and challenge
actively promote, facilitate good teamwork
skillful conflict resolution

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16
Q

Feedback is apart of ______ and it means

A

mutual support;
information provided to a team members for purpose of improving team performance

should be: timely, respectful, specific, directed, considerate

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17
Q

All health professionals should be educated to deliver _______

A

patient-centered care as members of an interprofessional team
emphasizing evidence-based practice
quality improvement approaches
informatics

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18
Q

Shared Mental Model is

A

Teams knowing what to expect –can regroup as needed
Optimal communication–everyone clear about the big picture
Helps team to predict and plan better
Team effort for the collective goals
Help to avoid errors

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19
Q

closed loop communication

verifies accuracy of conveyed information

A

check back

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20
Q

we expect patients to calculate

A

a measure doses
count pills
track amount of meds left & refill as necessary
use clocks and calendars to set time/day

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21
Q

I’m Safe Checklist

A 
I = Illness
M = Medication 
S = Safe
A = Alcohol and Drugs
F = Fatigue
E = Eating and Elimination
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22
Q

List Communication Techniques

A 
SBAR
Call-Out
Check-Back
Handoff
Briefs/Debriefs
Huddles
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23
Q

Mutual Support means

A

Take Assistance

Two Challenge Rule

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24
Q

process improvement after an event

A

debriefs

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25
Q

Two challenge rule is a part of _______ and it means _________

A

assertively voice a concern at least 2 times to ensure it has been heard
team members acknowledge the concern

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26
Q

What is the Team Structure

A 
Types
Clear roles
Shared vision + mental models
Strong leadership
Collective trust + confidence
Regular feedback
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27
Q

Cross monitoring

A

error reduction strategy

monitoring actions of other team members “watch each other’s backs”

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28
Q

problem solving, identify critical issues or concerns

A

huddles

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29
Q

CUS Words are a part of ________ and it stands for

A

Mutual Support
C = I am Concerned!
U = I am Uncomfortable!
S = This is a Safety issue

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30
Q

transfer of information or responsibility

A

handoff

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31
Q

2 Types of Teams

A

Core

Contingency

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32
Q

Proficient (green)

A

define medical term from complex document; calculate share of employee’s health insurance costs

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33
Q

the ability to understand and share the feelings of another

A

empathy

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34
Q

What health literacy evaluation is more reliable to identify those at risk of low/inadequate health literacy compared with confirming those with adequate health literacy

A

Single Item Literacy Screener SILS

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35
Q

we expect patients to read:

A

labels & inserts
names of medicines
dosage instructions
read between the lines (BID, TID, QID)

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36
Q

SILS has a STRONGER correlation with

A

s-TOFHLA and REALM

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37
Q

universal precaution is

A

the idea that you should treat all patients as if they have low health literacy until you can prove otherwise

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38
Q

A shorter version of TOFHLA is and it includes:

A

s-TOFHLA

36 reading questions & takes 7 minutes

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39
Q

what percent understood take with plenty of water?

A

59%–10th/11th/12th grade level

–more complex message limited comprehension

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40
Q

we expect patients to track experiences:

A

watch for side effects and seek appropriate help as needed

take action for. missed doses when needed

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41
Q

Health Literacy Risk Factors

A 
elderly
minorities
limited english proficiency (LEP) patients
low income
homelessness
prisoners
persons with limited education
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42
Q

list how health literacy affects people’s ability

A

navigate the health care system, filling out forms and locating providers and services;
share personal information, such as health history with providers;
engage in self-care and chronic disease management
understand mathematical concepts such as probability and risk

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43
Q

Approx. ______ of high school graduates have limited health literacy

A

45%

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44
Q

patients and pharmacists work together in relationship that is realistic, collaborative, based on respect and trust, committed to the work of treatment

A

Therapeutic Alliance

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45
Q

Difference between literacy and health level

A

Health info can overwhelm each person with advanced literacy skills;
although a pt read at high levels–doesn’t mean high health literacy level

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46
Q

Literacy vs Health Literacy

A

people who read well and are comfortable using numbers can face health literacy issues

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47
Q

types of appropriate response

A 
empathy
reassurance
probing
advising
generalizing or comparing
assertiveness
aggressiveness
nonassertiveness
judging
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48
Q

scientific domain

A

ability to understand basic scientific, concepts

ex: organs, medical text, risk statistics

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49
Q

REALM

A

Rapid Estimate of Adult Literacy in Medicine

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50
Q

bacteria

A

germs or bugs

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51
Q

supportive communications consists of

A

sadness, fear/anxiety, shame/embarrassment, guilt, anger

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52
Q

NAAL stands for

A

National Assessment of Adult Literacy

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53
Q

nonverbal behaviors

A 
head nodding
forward lean
direct body orientation
uncrossed legs and arms
arm symmetry
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54
Q

In REALM patients are asked to do what

A

pronounce a list of 66 common words related to anatomy or illness

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55
Q

SILS response scale

A 
1-5
1= never
2= rarely
3= sometimes
4= often
5= always
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56
Q

what is the shorter version of REALM and what do patients have to do

A

REALM-R and they have to pronounce a list of 8 common words related to anatomy or illness

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57
Q

civic domain

A

applying health info to make decisions regarding general public policy
ex: school board members making decisions on nutritious diet for school lunch; voters deciding whether tobacco should be banned in public

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58
Q

REALM has been highly correlated with

A

reading comprehension (reading-grade level) but does not directly measure comprehension of health information

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59
Q

dose

A

amount

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60
Q

the degree to which an individual has the capacity to obtain, communicate, process, and understand basic health information and services to make appropriate health decisions

A

health literacy

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61
Q

abstinence

A

not having sex

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62
Q

what percent understood do not take dairy, antacids, iron repair within one hour of medicine

A

8% –12th/13th grade level

–unfamiliar, multi-step instructions rarely understood

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63
Q

Tools to Improve Health Literacy

A

CMS 11-part toolkit

Federal Plain Language Guidelines

CDC Clear Communication Index

NIH “Pink Book” - Making Health Comm. Programs Work

Clear Communication - NIH Health Literacy Initiative

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64
Q

Basic or Below Basic level cannot do what on the National Assessment of Adult Literacy:

A

use a bus schedule or bar graph
explain the difference in 2 type of employee benefits
write a simple letter explaining an error on a bill

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65
Q

_____ literacy has been linked to poor health outcomes such as higher rates of hospitalization and less frequent use of preventive services

A

low

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66
Q

TOFHLA is

A

includes 50 readings and 17 numeracy items and takes about 22 min to administer

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67
Q

access

A

able to get

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68
Q

Therapeutic Alliance

A

realistic
collaborative
based on respect and trust
committed to the work of treatment

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69
Q

List some of the examples of health literacy including numeracy skills

A 
nderstanding cholesterol levels
interpreting blood sugar levels
measuring medications
comprehending nutrition labels
choosing between health plans or comparing prescription drug coverage--calculating premiums, copays & deductibles
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70
Q

SILS includes

A

asks one only one item on a 5 pt scale

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71
Q

we expect patients to talk to busy professionals

A

describe new feelings (side effects
present problems
ask questions

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72
Q

contaminated

A

dirty

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73
Q

NVS stands for

A

newest vital sign

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74
Q

screening

A

testing or checking

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75
Q

Adults with _____ health literacy were more likely to report their health as poor and ____ are more likely to lack health insurance than adults with _____ health literacy

A

Below Basic
42%
28%
Proficient

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76
Q

NVS correlates with

A

TOFHLA and s-TOFHLA

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77
Q

SILS stands for

A

Single Item Literacy Screener

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78
Q

handling patient emotions

A

respond to emotion with verbal and nonverbal cues
address emotions by reflecting back
encourage the pt to expand as appropriate
redirect the convo tactfully back to the goal of the encounter
often appropriate apologies, comfort, reassurance or support
maintain composure, use nonverbal cues and empathetic listening

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79
Q

fundamental domain

A

includes reading, writing, speaking and basic numeracy–what most people think of a general literacy

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80
Q

3 major problems associated with supportive communication

A

other person can decide to remain angry or uncooperative
defense resulting from certain situation or conditions can cause pts to displace a core emotion and replace it with anger or indifference at a time when they most need support
takes times, effort, and practice

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81
Q

How are results categorized for TOFHLA

A

inadequate
marginal
adequate

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82
Q

what percentage understood take with food

A

84%–1st grade level

simple, familiar wording

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83
Q

communication skills and techniques

A 
open discussion
gather info
understand pt perspective
share info
reach agreement on problems & plans
provide closure
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84
Q

cultural domain

A

incorporates beliefs, customs, and social identity into personal decision making

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85
Q

Four major health literacy domains

A

fundamental, scientific, cultural and civic domain

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86
Q

TOFHLA

A

Test of Functional Health Literacy in Adults

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87
Q

NAAL score on 4 levels

A

Proficient
Intermediate
Basic
Below Basic

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88
Q

NVS takes about and includes

A

brief tool 3 min

includes 6 questions on interpreting a nutrition label

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89
Q

identification with affective experience of the other
imitation
affective communication
can be painful at times
doesn’t mean giving in or giving up
one can be empathetic w/o responding empathetically

A

empathy

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90
Q

REALM takes about how many minutes?

A

3-6 minutes

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91
Q

Below Basic (red)

A

circle date on appointment slip; understand a simple pamphlet about pre-test instructions

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92
Q

Basic (orange)

A

Understand a simple patient education handout

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93
Q

patients and caregivers often present with emotions related to distress

A

supportive communication

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94
Q

Intermediate (yellow)

A

Determine healthy weight from BMI chart; interpret prescription and over-the-counter drug labels

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95
Q

Common medication related problems:

A 
Drug Interactions
Adverse Events
Excessive/Insufficient Dose
Excessive/Insufficient Duration
Cost Efficacy Concerns
Patient Overuse/Underuse
Needs Additional Therapy
Duplicate Therapy
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96
Q

Methods to detect medication related problems:

A

Drug-Utilization Review (DUR)
Opioid Monitoring System
Pharmacist Review
Patient Recognized Concern

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97
Q

Step 1: Method to resolve medication related problems:

A

Confirm it is a true medication related problem

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98
Q

Step 2: Method to resolve medication related problems:

A

Step Counsel patient

99
Q

Step 3: Method to resolve medication related problems:

A

Consult prescriber

100
Q

DUR

A

Drug-Utilization Review

101
Q

During Drug-Utilization Review & it requires

A

prescription processing system will alert you to a potential problem
requires pharmacist acknowledgment and approval before continuing the dispensing process

102
Q

What problems are usually identified during drug-utilization review (DUR)

A 
drug-drug interaction
drug-age interaction
drug-gender interaction
therapeutic duplication
over/under utilization
dose too high
103
Q

Opioid Monitoring System

A

the system vary by state
mixed utilization methods like every controlled fill, ever C2 controlled fill, if suspicious
NC Controlled Substances Reporting System (CSRS)

104
Q

CSRS

A

NC Controlled Substances Reporting Systems used for monitoring opiniods

105
Q

Pharmacist Review includes

A

everything the DUR is not programmed to catch like
dose/duration concern
disease interaction
cost efficacy alternatives
additional therapy that may be beneficial

106
Q

Patient recognized concern

A

patients usually will ask question or raise concern about cost-efficacy or adverse events

107
Q

During patient recognized concern they should be asked

A

about adverse events
other medical conditions for potential interactions or additional therapy
typical use to estimate overuse/underuse
efficacy of the medication regimen

108
Q

During Step 1 of resolving

A

confirm it is a tru medication related problem and if it is not the pharmacist can override

ex: if allergic to penicillin and dispensed amoxicillin previously pharmacist can override because no reaction to amoxicillin

109
Q

During Step 2 of resolving

A

counsel patient
may be able to resolve by talking directly with the patient

ex: overuse of albuterol; talking w/ pt discover not using asthma prevention medicine so explain diff b/t 2 medicines to decrease use of albuterol

110
Q

During Step 3 of resolving

A

consult the prescriber
usually discuss w/ pt before consulting w/ prescriber
gather all necessary info
for non-urgent medication related problems–fax prescriber w/ recommendation
for urgent medication problems–call prescriber w/ recommendation/solution

111
Q

ISMP

A

Institute for Safe Medication Practices

112
Q

ISMP provides

A

error-prone abbrev
confused drug names
high alert medications in acute AND community settings

113
Q

Prescriber communciation techniques

A

do homework before recommending
be clear, complete, concise, timely, professional & organized
develop rapport–watch terminology tone & body language
prepared to modify recommendation due to info or challenges from provider
combination of info exchange, assertiveness & effective listening

USE TEACH BACK & READ BACK METHOD
utilize standardized communication process such as SBAR

114
Q

OBRA

A

Omnibus Budget Reconciliation Act of 1990

115
Q

Why was OBRA developed?

A

Developed by federal govt to address the rising costs of Medicaid and Medicare programs

116
Q

Primary aim of OBRA

A

to save taxpayers’ money through better use of medicaitons

117
Q

Before OBRA-90 federal statue applied to

A

only medicaid pts

after OBRA all patients were included

118
Q

Impact of OBRA-90

A

state & federal govt prohibited from reducing Medicaid pharmacy reimbursement levels

pharmaceutical manufacturers required to give Medicaid programs “BEST” prices

119
Q

Requirements of OBRA-90

A

each state had to establish drug use review programs
each program had to have: prospective drug utilization reviews
retrospective drug utilization reviews
on-going assessments of drug data
educational programs

120
Q

Prospective Drug Review happens when

A

BEFORE each prescription is filled

121
Q

Prospective Drug Review shall include screen for :

A 
over/under utilization
therapeutic duplication
drug-disease contraindications
drug-drug interactions
incorrect dose or duration
drug-allergy interactions
clinical misuse/abuse
122
Q

NC offer to counsel can be presented by

A

ancillary pharmacy personnel such as
technicians
cashiers

123
Q

Who can counsel pts

A 
Pharmacists 
Pharmacists inters (WITH Pharmacist oversight/overseeing)
124
Q

If a patient refuses counseling

A

The pharmacist is not required to counsel if the patient refuses

125
Q

Acceptable ways to offer counseling:

A

Any way that poses the offer in an open-ended fashion AVOIDING yes and no

what questions do you have for the pharmacist

126
Q

Patient Medication Record Retrieval

A

Reasonable effort must be made to obtain record and maintain:
name, address, phone number, date of birth (or age), and gender
disease states, allergies, comprehensive list of medications
pharmacist’s comment on the individual’s drug therapy where appropriate

127
Q

Retrospective Drug Utilization Review happens when

A

AFTER each prescription is filled

128
Q

Retrospective Drug Utilization Review includes

Usually completed through drug claim processing and information retrieval systems

A

analyzing prescription claims data to identify patterns:
fraud or abuse
medication overuse
inappropriate or medically unnecessary drug therapy

129
Q

OBRA-90 Regulations counseling points could include:

A

brand name, generic name, other descriptive info
intended use / expected action
route, dosage form, dosage, administration schedule
common side effects encountered (including their avoidance and the action required if they occur)
techniques for self-monitoring of drug therapy
proper storage
potential drug-drug or drug-food interactions or other therapeutic contraindications
prescription refill information
action to be taken in the event of a missed dose

130
Q

Indian Health Service Model 3 Prime Questions to assess baseline knowledge

A

What did you prescriber tell you this medication is for?
How did your prescriber tell you to take this medication?
What did the prescriber tell you to expect from this medication?

131
Q

Teach Back Method

A

verify pt is picking up what you are putting down

lets pt verbalize their understanding

132
Q

Use what kind of questions for counseling

A

open-ended

133
Q

Did the doctor tell you what this medication is for?

What kind of question is this? Should it be avoided or utilized during patient counseling

A

Closed-ended

AVOID

134
Q

This medication hasn’t caused you any problems has it?

What kind of question is this? Should it be avoided or utilized during patient counseling

A

Leading question

AVOID

135
Q

You are taking this twice a day right?

What kind of question is this? Should it be avoided or utilized during patient counseling

A

Leading question

AVOID

136
Q

What did your prescriber tell you about this medication?

What kind of question is this? Should it be avoided or utilized during patient counseling

A

Assessing Baseline Knowledge

UTILIZE

137
Q

How do you feel about taking this medication? What concerns/worries do you have?
What kind of question is this? Should it be avoided or utilized during patient counseling

A

Assessing Comfort Level

UTILIZE

138
Q

How are you going to take this medication?

What kind of question is this? Should it be avoided or utilized during patient counseling

A

Teach Back Method

UTILIZE

139
Q

The extent to which patients to take medication as prescribed by their doctors

A

Medical Adherence

140
Q

Medical Adherence involves multiple factors such as:

A

getting prescriptions filled
remembering to take medications on time
understanding the directions

141
Q

Types of Communication Barriers

A 
Language
Hearing
Vision
Low Health Literacy 
Cultural
142
Q

Language & communication problems may lead to:

A

patient dissatisfaction
poor comprehension
lower quality of care

143
Q

Why is effective communication important?

A

Helps patients take charge of their care

Can help foster a good working relation b/t you and pt

Increase day-to-day operating efficiency

reduce chance of medical errors

in order to give fully informed consent, pt need information they can understand

144
Q

All health care providers who receive Federal funds MUST ensure equal access to services

A

Civil Rights Act

145
Q

All health care providers (regardless of funding) MUST provide effective communication, free of charge, to patients (and companions) with disabilities

A

Americans with Disabilities Act

146
Q

Based on statute, regulation, and case law, the informed consent process requires explanations of the benefits and risks of treatment alternatives

A

Informed Consent

147
Q

Tips for Effective Communication

A

be descriptive
address the person by name
actively listen
tailor your technique and approach to each patient
allow time for patients to process the information and ask questions–silence is okay
utilize open-ended questions and the teach back method

148
Q

LEARN Model stands for

A 
Listen
Explain
Acknowledge
Recommend Treatment(s)
Negotiate Treatment(s)
149
Q

What does L mean in the LEARN Model

A

Listen with empathy and understanding to the patient’s perception of the problem

150
Q

What does E mean in the LEARN Model

A

Pharmacists should EXPLAIN their perception of the problem followed by…

151
Q

What does A mean in the LEARN Model

A

Acknowledging the differences and similarities of both perceptions

152
Q

What does R mean in the LEARN Model

A

The pharmacist then RECOMMENDS TREATMENT all while maintaing patient involvement

153
Q

What does N mean in the LEARN Model

A

Negotiation of treatment occurs which should be a combination of ideas combing from both the pharmacist and patient

154
Q

LEARN allows

A

pharmacists to build trust, open communication and negotiate treatment with patients

155
Q

1 out of _ patients either do not speak English or speak English as a second language

A

4—

this is apart of language barrier

156
Q

Qualifiied Medical Interpreters could be

A

certified freelance interpreters
employees from language agencies
trained bilingual clinicians and staff
community-based medical interpreters from local colleges, faith-based organizations, social services programs, migrant health clinics and etc

157
Q

What is the pharmacists role in language barrier patients?

A

culturally appropriate, translated materials written in plain language

visuals (pictures/graphs)

158
Q

Immunization in different language can be retrieved from

A

immunize.org
Medline Plus
Healthy Roads Media
Health Information Translations

159
Q

__ out of ___ are either deaf or hearing impaired

A

3 out of 100

hearing barriers

160
Q

Hearing Barrier patients may have difficulty

A

understanding the different roles in pharmacy
reporting adverse events
understanding medication administration technique

161
Q

What is the pharmacists role in hearing barrier patients?

A 
printed material
written instructions
videos w/ captions
revised labeling to make clear warnings
highlighting the appropriate time and method to take the medicine
162
Q

__ out of __ individuals are blind or have severe trouble seeing, even with glasses

A

2 out of 100

vision barriers

163
Q

Vision Barrier patients may have difficulty

A

understanding administration techniques
viewing medication instructions
reading patient education materials

164
Q

What is the pharmacists role in vision barrier patients?

A

speak in quiet area

print prescription label & handouts using braille, raised lettering, large letters, & visual aids

provide patient with magnifying glass

record pt info for them

educate pt about available technology

165
Q

Technology Device Available for

A

audio recordings
screen reader software
video conferencing
talking prescription labels & glucose monitors

166
Q

how to be sighted guide

A 
offer assistance
offer arm by tapping pt palm
pt will grasp arm above elbow
walk at comfortable space--stay one step ahead
describe turns, doorways & chairs
tell person when leave room
ask to touch guide dog
167
Q

The ability to obtain, process, and understand basic health information and services needed to make appropriate health decisions

A

Health Literacy

168
Q

Factors that can influence an individual’s health literacy

A 
living in poverty
education
race/ethnicity
age
disability
169
Q

Patient Friendly Education Materials should be

A 
max 1 page front and back
minimum 12 pt font
use of visual aids
communication should be 5th grade reading level
leave lots of white space
DONT use fancy/script lettering
170
Q

Involves ensuring that the needs of diverse patients are met by health professionals based on valuing diversity and taking concrete steps to ensure efficacy in serving the minority

A

Cultural Competency

171
Q

Cultural Competency affects

A

patient health beliefs, treatment choices, & Prevention strategies

172
Q

Cultural Competency Framework

A 
Awareness
Knowledge
Skill
Encounters
Desire
173
Q

Examples of Cultural Competence

A 
Health Beliefs
Religion
Family/Culture
Gender/Sexual Orientation
Attitude towards health care workers & health Care
174
Q

Ones belief on the cause, treatment and prevention of an illness

A

health beliefs

ex: apple a day keep doctor away

175
Q

impact one’s choice of prevention and treatment of illnesses

A

religion

ex: catholics and contraceptives

176
Q

Each ethnic group brings its own perspectives and values to the health care system

A

family/culture

177
Q

identity differ from the gender/sex assigned at birth

A

transgender

ex: trans woman refers to a woman who was assigned male at birth

178
Q

identify with the gender assigned at birth

A

cisgender

179
Q

assignment of people as male or female based on external genitalia at birth

A

sex

180
Q

person’s physical or romantic attraction to others

A

sexual orientation

ex: heterosexual, gay, lesbian, queer

181
Q

inability to afford health care causes distain and fear leading to

A

avoidance

182
Q

2nd barrier to cross-cultural communication

A

nonverbal communication

183
Q

up to 70% can be attributed to

A

nonverbal components of communication

184
Q

SOLER is an

A

non-verbal communication–active listening model

185
Q

What does the S in SOLER stand for?

A

square

face squarely by doing this it shows you are involved

186
Q

What does the O in SOLER stand for?

A

open

keep an open posture this means not crossing arms/legs & it makes people feel engage and welcome

187
Q

What does the L in SOLER stand for?

A

lean

by leaning forward when a person is talking to you it shows you’re involved and listening to what they have to say

188
Q

What does the E in SOLER stand for?

A

eye contact

use good eye contact–your gaze shows that you’re listening and not distracted

except when pt belongs to group that considers eye contact rude/intimidating

189
Q

What does the R in SOLER stand for?

A

relax

its important to stay calm and avoid fidgeting when a person is talking to show you are focused

190
Q

providers spend approx. how much time explaining newly prescribed medications during a patient appointment

A

less than 1 minute

191
Q

Months with 30 days

A

April, June, September & November

February has 28 unless leap year then it has 29

192
Q

30 days supply should last how long

A

1 month

193
Q

90 days supply should last how long

A

3 months

194
Q

direct methods of measuring medication adherence

A

direct observed therapy
measurement of drug concentration in blood
measurement of the biological marker in the body

195
Q

indirect methods of measuring medication adherence

A 
patient self-report
pill counts
pharmacy fill data
electronic medication monitoring
assessment of patient's clinical response
196
Q

2 Calculation Adherence Metrics

A

Medication Possession Ration (MPR)

Proportion of Days Covered (PDC)

197
Q

MPR

A

medication possession ratio

198
Q

PDC

A

proportion of days covered

199
Q

MPR =

A

(# of fills x days supply for each Rx dispensed)

divided by

number of days in period

200
Q

patient is considered adherent if the MPR is

A

greater than or equal to 80%

201
Q

MPR measures what

A

measures the percentage of time a patient has access to a medication

202
Q

when would MPR be skewed

A

when receiving automatic refill or when obtaining medications earlier than needed

–maybe greater than 100%

doesn’t actually tell whether pt being adherent or not

203
Q

PDC =

A

(# of tablets x refills)

divided by

number of days in period

204
Q

PDC is considered adherent if the PDC is

A

greater than or equal to 80%

205
Q

Why do some medications require greater level of adherence to avoid negative outcomes

A

to avoid risk of drug resistance

ex: HIV medications

206
Q

use PDC when patients are on 3 medications so if 2 drugs are picked up

A

the PDC cannot be calculated

a day is considered “covered” when all 3 medications are available to patient

207
Q

Limitations to MPR and PDC are

A

inhalers, nitroglycerin, liquids, eyedrops, patient awaiting administration technique, Incorrect estimation of adherence (directions have changed or medication set to auto-refill)

208
Q

Barriers to Medication Allowance

A 
Condition Related
Social/Economic
Healthcare System
Patient Related
Therapy Related
209
Q

Condition Related medication adherence

A

lack of symptoms associated with conditions
disability
psychotic disorders
depression
severity of symptoms
rate of disease progression (5 days left ot live)
substance abuse

210
Q

Social Economic medication adherence

A

lack of family or social support
unstable living conditions
limited English language or health literacy
beliefs about illness and treatment
lack of health insurance
medication costs
difficulty access pharmacy (transportation)

211
Q

Healthcare Factors mediciation adherence

A

access to care
transitions of care
high drug costs
reading level of patient education materials
patient-provider relationship
provider communication skills
lack of positive reinforcement or empathy
ability to educate patients and provide follow up

212
Q

Patient related medication adherence

A

physical factors -visual/hearing/mobility/swallowing

psychological factors - knowledge/motivation/perceived benefit–side effects/understand why need it

213
Q

Therapy related medication adherence

A

medication regimen complexity

social stigma (other people knowing)
acute/perceived side effects
interference with lifestyle
214
Q

adherence intervention SIMPLE stands for

A 
Simplify Regimen
Impart Knowledge
Modify patient beliefs and behavior
Provide communication and trust
Leave the bias
Evaluate adherence
215
Q

Simplifying Regimen of adherence intervention

A

adjust timing–take before TV shows

avoid medications with special directions

216
Q

Impart Knowledge of adherence intervention

A

shared decision making
involve patient family
pt homeless so pharmacist talk to dr about oral medicine instead of insulin because no where to store it

217
Q

Modify Patient Beliefs and Behavior of adherence intervention

A

educate patients on the risks of non-adherence AND benefits of taking their medications

address pt fears/concern like side effects

empower pt

218
Q

Provide Communication and Trust of adherence intervention

A

improve interviewing skills
active listening
emotional support
put pt input into their treatment like giving them option of oral pill and if they take it correctly wont do insulin

219
Q

Leave the Bias of adherence intervention

A

Address patient-provider dissonance

ex: I know you are taking this medication already. You have been taking it every AM on empty stomach right?

220
Q

Evaluate adherence of adherence intervention

A 
self-report
MPR
PDC
medication adherence scales
biochemical tests
review fill dates
221
Q

Strategies for Patients

A

automatic refill programs
utilize pill box
setting phone reminders
90 day supply fills

222
Q

Strategies for Pharmacists

A 
identify cost-cutting strategies
sync medications to be picked up on day
engage the staff
help pt customize support tools
education pt what to expect
nurture relationships with patients
223
Q

Personality tests are

A

trait measurement tools that measure and quantify human attributes

224
Q

Examples of Trait Measurement Tools

A

Meyers Briggs
HEXACO Personality Inventory
Isenberg Entrepreneur Test
Clifton Strengths

225
Q

Transition to the 2nd half of life

A

see yourself as you are
recognize needs & wants
move w/ purpose–take the next best step

226
Q

4 Clifton Strengths Domains

A

Executing
Influencing
Relationship Building
Strategic Thinking

227
Q

Executing

A

make it happen
work tirelessly
make it reality

228
Q

Influencing

A

reach audience
strength to influence
sell an idea inside or outside the organization

229
Q

Relationship Building

A

holds team together

230
Q

Strategic Thinking

A

future

231
Q

Native Genius

A

really good at it something you would do anywhere no matter if you got paid to do its because its your strength

232
Q

the act or process of becoming the people we are called to become emotionally, socially, physically and professionally

A

self-leadership

233
Q

first step toward effective interpersonal relationships and group dynamics

A

self knowledge

234
Q

self knowledge consists of

A

cognitive (know)
affective (feel)
psychomotor (do)

235
Q

cognitive

A

know
physical attributes
objective facts
knowledge and skills

236
Q

affective

A

feel
feelings
emotional intelligence
social interaction

237
Q

pscyhomotor

A

do
physical actions
professional behavior

238
Q

theory of self knowledge

A

Johari Window

239
Q

open area

A

something you know and others know

240
Q

blind area

A

unknown to me but others know it about me

241
Q

hidden area

A

i know about me but you dont know about me

242
Q

unknown area

A

unknown to me and unknown to others

243
Q

shared belief that the team is safe for risk taking

A

psychological safety

P1 Pharmacy Practice (37 decks)

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