Communication and Concordance Module

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Communication and Concordance Module

• Medication Review Matters

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What this module is about.

• Background to cognitive services
• Types of communication needed for HMR
• GPs
• Patients
• What systems help patients to reach concordance
• Research that was the background to HMR
• Why the HMR rules are the way they are
• Complete Service Implementation Module

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Senior Care Pharmacy Innovation

• Penny Shelton Pharm D provides a medication
  management service
• Investigative pharmacist in USA
• Provides medication services to seniors
• Uses interviews
• Time management
• Works with GPs
• Uses empathy
• Needs patience

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Australian Medication Management Service
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• Chen,Crampton,Krass 1999
• Invitation to all GPs and pharmacists in a
  Division of General Practice
• Dinner Meeting with GPs and pharmacists
• Medico Pharmacy Committee
• Dinner meeting with GPs and pharmacists
• Trained community pharmacists
• Medication review by pharmacists
• Meetings between GPs and pharmacists to report

Case Studies
PAG
Accreditation
Risk factors
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Australian Medication Management Service
2

• Rigby,Roush,Watts 2000
• GP referral to a community pharmacy
• Medication assessed

HMR Model
Risk factors
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Australian Medication Management Service
3

• Dr John Aloizos Chair AGPN
• Discussion of BMJ article regarding
  misunderstanding around medicines management. One
  was St George project from USYD
• GP referral to trained community pharmacists
• 60 patients reported increased understanding
  about medicines

Risk factors
HMR Model
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Communication

• Pharmacists are highly respected and trusted
• To conduct medication review
• Good communication skills
• Good negotiation skills
• Non-threatening strategies to help patient

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Basic communication

• Verbal
• 40 message
• Accept their views
• Be empathetic
• Express support
• Tone (reflects feelings)
• Pitch (gives emphasis)
• Exercise
• Each person say the sentence with a different
  emphasis
• My cats are in the bedroom

• Non verbal
• 50 message
• Eye contact
• Posture
• Watch for non verbal clues
• Exercise
• Participants have to guess the non verbal
  message. FOUR people ACT to show
• SHY
• ANGRY
• AGGRESSIVE
• IMPATIENT

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Phone communication

• Care with words
• First 3 seconds important
• Greeting crucial
• Posture can affect tone
• Be careful with answering machine, words can
  sound rushed, garbled
• Background noise can reduce importance
• They know when you are smiling!

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Communication..Negotiation

• Identify objectives
• Debate positives and negatives
• Discuss possible outcomes
• Explore variables
• Collaboration and compromise

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Communication under difficult circumstances

• Mental Incapacity
• Consider ability to cope with Activities of Daily
  Living
• Reliability
• Hearing impaired
• Short sentences
• Speak slowly
• Write notes
• Visually impaired
• Help with organisation
• May need DAA
• EMPATHY, PATIENCE,UNDERSTANDING

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Consumer Rights

• Consumer Health Forum has a Charter of Rights
  for consumer
• Safety, be protected from hazardous products
• Be informed, given the facts
• To choose products or services
• Be heard, have a voice in policy
• Be educated, acquire knowledge

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Information gathering in HMR

• Preparation
• Quiet, private area
• Look professional
• Introduce yourself
• Be respectful
• Be discrete
• Dont disagree
• Observation
• Organisation
• Management
• Obvious problems

• Listen
• Information not always gained from questions
• Language
• Start with general questions
• Establish rapport
• Ensure confidentiality
• Avoid professional jargon
• Use non threatening language
• Responsive
• Empathetic

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Be a member of Health Care Team

• GP
• Community nurse
• Physiotherapist
• Occupational therapist
• Pharmacist
• Interprofessional communication

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HMR Report

• Opportunity to provide information regarding
  patient use of medicines
• Structure
• Medication list
• Medication management issues from interview,
  storage
• Medication related issues
• Language
• Clear, concise, succinct language
• Spellcheck
• Findings are the reason for the recommendation

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Relationship with GP

• Introduce yourself
• Be involved with combined events
• Invite GP to pharmacy
• Ask how they want HMR reports delivered
• Check if they find your reports useful
• Check if they need help to initiate HMR

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Compliance and Concordance

• Compliance measure of how the patient is
  adhereing to regimen
• Concordance Acknowledges the role of patient is
  taking an active role in their health care
• 19-28 do not attend after making a GP
  appointment
• 6-20 do not collect collect scripts from
  pharmacy
• 30-50 do not follow direction on label

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What can lead to non compliance?

• ALSO
• Misunderstanding
• Forgetfulness
• Other people meds
• Dose discrepancies
• Apathy
• Complex regimen
• Real adverse effects
• Alcohol use
• Taking too much
• Taking too little
• Storage

• ALSO
• No faith in regimen
• Denial of disease
• Stockpiling
• Symptoms disappearing
• Concern about addiction
• Concern about adverse effects
• Concern about finance
• Cannot swallow
• Cannot open packs
• Cannot get prescriptions

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Reading Joanne KaldyDont dread them, Learn how
to deal with them

• Reasons why
• people are negative
• Could loneliness
• Could be unhappiness
• Poor understanding
• Poor experience
• Cry for help

• Strategies to deal with difficult people
• Be calm, friendly
• Give feedback
• Dont take attacks personally
• Listen
• Investigate their understanding
• Dont expect change
• Ask questions
• Be discreet, gracious
• Come back later
• DOCUMENT everything

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Reading Marie GardnerPatient assessment
approach to MR

• Objectives of assessment
• Control disease
• Control complications
• Control adverse effects
• STEPS
• Plan your interview
• Be prepared
• Do homework

• Is medication working?
• Is dose high enough to reduce complications?
• Os patient showing adverse effects?
• Should dose be reduced to avoid adverse effects?
• Are there interactions that could be avoided?
• Does the combination cause adverse effects?
• Is the patient aware enough to understand
  treatment?

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Reading Pharmacy and Physicians David
Buerger - Teamwork Building Strategies

• TO START the relationship
• Introduce yourself to GPs and explain that
  reviews are review of what patient is doing
• Meet GPs in informal as well as formal
  environment
• Engage in similar activities
• Recognise GP role as team leader

• HOW TO make it happen
• Report factual information
• Define problem
• Initiate discussion
• Provide evidence as required
• Show how recommendation can improve outcome for
  the patient

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Reading Michael MajorResolving Pharmacist GP
Conflict
GPs and pharmacists need to be aware of each
others skills and roles

• GPs are clinicians
• GPs have their own experience
• GPs will use evidence if they feel it is suitable

• Pharmacists need to
• Introduce themselves
• Take the time to explain their role
• Not work in isolation

Getting recommendations accepted is 15
technical expertise and 85 interpersonal
competence
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Reading Achieving Shared Goals from
Compliance to Concordance

• CONCORDANCE
• Research suggests that if a patient
  understands why they are taking their medicines
  they will make a commitment to take it
• Royal Pharmaceutical Society
• of Great Britain

• PRACTICAL INTERVENTIONS
• Educate patient
• Discuss how and when they take medicine
• Discuss outcomes
• Discuss lifestyle
• Check dispensing history
• Other Drs
• Other drugs
• Pick up dates
• Give written information
• Give reminders, DAA

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Reading Shajahan Yasin Australian Family
PhysicianDetecting and Improving Compliance
Detecting non-compliance1. Response to treatment
2.Monitoring attendance3. Counting pills 4.
Asking patient

• Poor compliance
• Duration of treatment
• Duration of disease
• Complexity of treatment
• Number of drugs

• Better compliance
• Degree of disability
• Amount of supervision
• Meeting patient expectations
• Patient satisfaction with care

Strategies to enhance compliancePatient centred
approach 2. Direct patient attention to problem
3. Reduce missed appointments 4. Make a contract
with patient 5. Educate to appreciate benefits 6.
Support at home 7. Simplify regimen 8. Follow up
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Resources

• Professional Standards medication review PSA
• Professional Guidelines Concordance assessment
  PSA
• Guidelines for services to patients with visual
  impairment PSA
• Guidelines Dose administration aids PSA
• Therapeutic Guidelines
• Drug Interactions Facts and Comparisons
• Merck Manual
• Medical Dictionary
• Aus Di
• MIMs
• Herbal Medicines Newell et al
• Herb contraindications and DI Baker

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Websites

• www.health.gov.au
• www.docguide.com
• www.medscape.com
• www.mja.com.au
• www.ctonline.com.au
• www.bmj.com
• www.lancet.com
• www.nejm.com
• www.americanpharmacist.com
• Download the self assessment
• and include in QCPP