1. PHRM 3900: Pharmacy Communications Matthew Perri, Ph.D., R.Ph. Professor of Pharmacy Clinical and Administrative Pharmacy Room 260C Ph:542-5365 mperri@mail.rx.uga.edu

3. Communications Toolbox Notice this one is empty…

5. Plan for today: Course overview & introduction –ID Cards Name, where you are from, any prior degrees, something about yourself that will help me remember you –Course Web page The pharmacy care process OBRA 90 and Pharmacy Care Common communication mistakes health practitioners make Basic communication skills

6. The Pharmacy Care Process Collect and use patient information Identify patients’ drug related problems Develop solutions to these problems Select and recommend therapies Follow up to assess patient outcomes

7. OBRA 90: Three parts: –Patient Information –Prospective Drug Utilization Review –Patient Counseling Public Law 101-508, S4401, 1927(g) (November 5, 1990) and OBRA 90 Regulations. Federal Register November 2, 1992;57FR(212):49397-49401.

8. Patient Information Full name Address and phone Date of birth (DOB) / age Gender Drug list (profile) including all OTC, Rx, herbal supplements, etc. Pharmacist comments Chronic medical conditions (diagnoses) Keep for 2 years

9. Prospective DUR Over / underutilization Therapeutic duplications Drug-disease interactions Drug-drug interactions Incorrect dosage or duration of treatment Drug allergy interactions Clinical abuse - misuse

10. Patient Counseling Name (generic) Intended use and expected action Route, dosage form, dosage and administration schedule Special directions for preparation, storage or administration Precautions to be observed while taking Common side effects, how to avoid or action required if they occur Techniques for self monitoring of drug therapy Potential interactions or therapeutic contraindications Refills What to do if you miss a dose Any other information THIS patient may need to ensure safe use

11. Basic Communication Skills in Pharmacy Practice

12. The Communication Model

13. The communication model: Communication takes two –sender and receiver To optimize communication we must consider the “channel” Two way flow of information Potential for a breakdown to occur at any time Barriers will exist – minimize these when you can Communications Skills in Pharmacy Practice, Tindall, Beardsley and Kimberlin, third ed., 1994, Lea and Febiger, p 15.

14. Barriers to communication Pharmacy Environment

15. Barriers to communication Pharmacy Environment

16. Barriers to communication Barriers to communication

17. Basic Counseling and Communication Skills Courtesy and rapport: –Quite possibly the most critical skills you will need to develop, and includes: How to address patients Introducing yourself Learning patient names Being aware of your appearance, attitude, issues Respecting patient privacy issues Avoiding stereotypes Using appropriate body language

18. Body Language Message impact: 7% verbal 38% vocal 55% body movements Often more believable than words Composed of Body movements Facial expression Gestures Posture and breathing Space

19. Basic Counseling and Communication Skills Body language (we will spend more time on this later) –Facial expression – smile –Eye contact –Open posture –Distance –Tone of voice –Get “CLOSER” –Control distractions, lean in, open posture, smile, make good eye contact, relax

20. Some samples of facial body language….

22. Bringing it home to pharmacy, is this an example of good body language for a pharmacist?

23. Stereotypes The process of attributing a set of characteristics to all members of a group, without regard for individual differences. –We all react differently to different kinds of people, and even differently at different times. Some reactions are overt, some hidden. They all can impact how we relate to patients. We want to avoid letting stereotypes influence how we react to and interact with our patients. –Example statements: “Doctors are arrogant” “You can’t trust…(fill in with your favorite; men, women, college students, professors, etc.)” “Teenagers are irresponsible” Hugman, B. Healthcare Communications, Pharmaceutical Press 2009: p50.

24. A stereotype in action: I’m not feeling very well – I need a doctor immediately. Ring the nearest golf course. Groucho Marx

25. Stereotypes Common and most everyone holds to some degree of stereotyping What is the impact of this on rapport? Being aware of how you may stereotype others is critical Treat everyone as an individual

26. Rapport A level of mutual consideration and respect –The “warm fuzzy” part of communication –Paves the way for good communication Trust is critical –How do you build trust? –How do you keep it? –What happens when you break it?

27. Perceptions

28. FINISHED FILES ARE THE RE- SULT OF YEARS OF SCIENTIF- IC STUDY COMBINED WITH THE EXPERIENCE OF MANY YEARS OF EXPERTS

30. Listening

31. Basic Skills: Listening Listening Skills: –Be aware of perceptions (F test) –Be non-judgmental –Be an active listener Summarizing, paraphrasing, clarifying, feedback (immediate, honest and supportive) –Use appropriate listening body language –Use silence where appropriate Listening Skills: –Sit up. –Look and act interested. –Lean forward. –Actually Listen! –Nod your head to show your attention. –Make eye contact with the speaker.

33. Basic Skills: Information When communicating important information to patients, be sure to: State the purpose of your communication Inquire about what the patient needs Use markers for critical information –“Now, Ms. Smith, this is really important…..I need you to…” Talk in lay terms, but don’t oversimplify –Avoid technical jargon –Avoid information overload –Keep it short and simple, to the point

34. Basic Skills: Gathering Information When gathering information –Ask open-ended questions Much more information can be gained Saves time Provides opportunities for patients to reveal information we might not be thinking about –“How are you supposed to be taking this…? –“Tell me more about this…”

35. Basic Skills: Assessment The question is, did your patient learn anything from you? In other words, did the other person understand what you said, and meant? To assess: –Summarize your teaching –Verify what your patients know “Ms. Smith, can you tell me how you will take your medication? –Reinforce patient understanding when you can “That’s right, this medication will make you sleepy…”

36. Basic Skills: Empathy Seek to understand what your patients feel Empathy is not sympathy Realistically, may not be attainable because you are not the other person Empathy will help you shape your communication so that others better understand you! Listening and Responding Test: (p47 Tindall Book)

37. Basic Skills: Questions Encourage patients to ask questions –“Just let me know if you have any other questions, OK? Key Point: When your patients are comfortable asking you questions, you know you have rapport and are doing a good job communicating.

38. Basic Skills: Assertiveness and Persuasion Assertive versus aggressive. Persuasive versus pushy. –What is the difference?

39. Counseling Methods We Will Learn: Basic Counseling –Interactive patient counseling The Prime Questions Counseling in challenging situations –The PAR technique Prepare, assess and respond Counseling for compliance –The RIM technique Recognize, identify and manage

40. Face Reading: Art not Science LightForehead Eyebrows: shape, position, type Eyes: spacing, angle, bulging, size of iris, corner indents, pupil response, showing stress EyelidsEyelashes Eye Puffs Nose: size, shape, ridge, width, nose tip angle, Nose tip Nostrils Ears: size, cups and ridges, angle to head, placement Cheeks Mouth: size, angle Lips: size and shape Teeth Smiles Chins Combinations of features (Chin/eyebrow ) Lines Facial hair Fulfer, Mac, J.D., Amazing Face Reading, 1996.