Module 1, Patient centred care Flashcards
What are the key principles of PCC?
- *1. bio-psycho-social perspective:** broadening the focus of the pharmacist-patient interaction to include psychological and social factors as well as physical symptoms
- *2. patient as a person:** exploring the meaning of illness and health to each individual patient
- *3. sharing power and responsibility:** including the patient in decision making and considering them to be an expert in their own health
- *4. therapeutic alliance:** valuing the relationship between pharmacist and patient as a means of promoting health
- *5. pharmacist as a person:** Pharmacists are not interchangeable, the particular qualities, attitudes and values of the doctor are important and will suit one patient better than another
What are the goals of PCC?
- to understand the illness experience of the patient
- to understand each patients experience is unique
- to build a therapeutic alliance with patients to meet mutually understood goals
- develop self awareness of personal effect on patients
- to foster an egalitarian relationship with the patient i.e. patient is a member of the health care team
What are the 8 dimensions of PCC?
1 Patients preferences 2 Emotional support 3 Physical comfort 4 Info & education 5 Continuity & transition 6 Coordination of care 7 Access to care 8 Fam & friends
What are some benefits of PCC?
- positive outcomes in chronic health problems
- increased patient satisfaction, QOL, engagement
- Reduced patient anxiety
- Improved professional satisfaction
- Improved business outcomes
What are some barriers to PCC?
Staff or clients with poor communication Workforce issues Time constraints Lack of private consulting areas Poor implementation & change management strategies Variable support from GPs & pharmacy owners
How to overcome these barriers?
Shift in mind set Practice & experience Train staff & lead by example Life-long learning Rethink organisation Environment
Which documents highlight patient centrered counselling?
- Competency standards
- Professional Practice Standards
- Code of Ethics for Pharmacists
- Sixth Community Pharmacy Agreement - Pharmacy Guild of Australia (will be in 7th CPA)
What are some ways to clarify patient ideas?
“I’m not clear about that- tell me again” “Let me see if I have understood that correctly?” “Let me check to see if i understand what you’ve told me so far… sounds like… have i got that right?
What are some of the CODE OF ETHICS for pharmacists relating to PCC?
- respects the dignity and autonomy of the patient
- recognises and respects patients’ diversity, cultural knowledge and skills, gender, beliefs, values, characteristics and lived experience, and does not discriminate on any grounds
- encourages patients to participate in shared decision-making, and assists by providing information and advice relevant to the patient’s clinical needs in culturally appropriate language, detail and format
- explains the options available, including the risks and benefits, by providing information that is impartial, relevant, up-to-date and independent of any personal commercial considerations to help patients make informed decisions
- consults with an appropriate carer or substitute decision maker if the patient lacks the capacity to provide consent
- respects the patient’s choice, including the right to refuse treatment, care or advice, or to withdraw consent at any time
- ensures compliance with the patient’s legal right to privacy and confidentiality as outlined in the Australian Privacy Principles* with appropriate security and safeguards applied to digital and hard copy information
- informs the patient when exercising the right to decline provision of certain forms of health care based on the individual pharmacist’s conscientious objection, and in such circumstances, appropriately facilitates continuity of care for the patient
What are some ways to respond to the patients feelings?
“This must be very hard for you. Now i understand your situation better.” “I want to help you in anyway I can. Please, let me know what you expect me to do to help.” “Thanks for letting me know how you’ve been going. This info will help me know how I can support you/ or what treatment options we can look at together.” “Oh this must be a difficult time. I’ve seen similar kinds of issues in other patients. I hope you know we are here to help you.”
Outline the features of a patient centred communication as opposed to traditional medication centred counselling…
What are some ways “phrases” we can use to encourage sharing of ideas and feelings?
- Check the environment – privacy, tissues, seating
Begin with open-ended questions such as: ‘‘What can I do for you today?’’ – may lead to a task orientated response
“How are you today?” ‘
‘Can you tell me more – whatever you feel is important?’’
‘‘What do you think might be causing your problem or illness?’’ - Try to reflect back what they said, paraphrase
“so you feel…”
“sounds like you are…” - Look for cues - esp. non-verbal
How do we respond to patients feelings?
- ‘‘This must be very hard for you. Now I understand your situation better.’’
- ‘‘I want to help you in any way I can. Please, let me know what you expect me to do to help.’’
- “Thanks for letting me know how you’ve been going. This information will help me know how I can support you/ or what treatment options we can look at together/ or what information I can give you.”
- ‘‘oh this must be a difficult time. I have seen similar kinds of issues in other patients. I hope you know we are here to help you.’’
An example of a patient centred communication…
What practical things did the pharmacist do to involve the patient?
- Encouraged the conversation by reflecting what patient had said and then asking open-ended questions to elicit more information
- Reacted to patient cues – sighing, no eye contact, abrupt response – patient was unsure or ambivalent about taking meds, was surprised by diagnosis
- Let patient decide what information and knowledge to share
- Elicited patient’s own expectations, views of the symptoms, concerns, fears and other feelings
- Elicited other physical and biopsychosocial information – FIFO worker, conflict in marriage, has friend with depression, has sore neck and shoulders, initial complaint was insomnia
- Invested in the beginning, encouraged a therapeutic relationship
- Involved the patient in the treatment plan
