AN EFFECTIVE CLINICAL PHARMACIST COMMUNICATION MAY BUILT PATIENT TRUST ON PHARMACIST OVER OTHER HEALTHCARE PROVIDERS: EVIDENCE BASED PRACTICE

AN EFFECTIVE CLINICAL PHARMACIST COMMUNICATION MAY BUILT PATIENT TRUST ON PHARMACIST OVER OTHER HEALTHCARE PROVIDERS: EVIDENCE BASED PRACTICE

Maria Ayub*, Somia Gul, Nusrat Afzal and Asma Eraj

Faculty of Pharmacy, Jinnah University for Women, Karachi, Pakistan

ABSTRACT: Clinical pharmacists are integral part of patient healthcare team. They tend to serve as key element in patient care provide quality of care to reduce ADR (adverse drug reactions),improve patient compliance, effective drug cost and make role of  pharmacist evident in healthcare sector and society. For the purpose of evaluating patient outcome failure from treatment, a retrospective study conducted where clinical pharmacist were directed to pay their role in evaluating mechanism behind failure of treatment. About 300 patients from different healthcare sector were included particularly of with chronic illness and those reported with poor compliance. They disclose many horrible facts and identify mechanism in poor response of therapy. By special counseling in separate area by clinical pharmacist patient reveals many fact in failure about 31% due to improper counseling, 61% undesirable taste, 5% ADR,41% due to psychological burden of long treatment and only 11% were receiving psychological treatment with 59% were not satisfied with physician response. After introduction of clinical pharmacist, there is a remarkable improvement in outcome of treatment with patient trust built on pharmacist as they believe on clinical pharmacist as integral part of their health care provider and clinical pharmacist achieved their target 40% enhancement in patient hope for their life.

Pharmacist role, Patient care, Healthcare system, Clinical Pharmacist role, quality of care

INTRODUCTION: Clinical pharmacist tend to serve as an integral part of healthcare sector by incorporating effective role in reducing medication error in wards dealing with infection and critical care which reflects positive impact of pharmacist regarding prevention of medication error ¹. pharmacist involvement at healthcare centers proved dedicated role in clinical time and in minimizing medication related discrepancies and clinical pharmacist involvement proved gradual decline in medication error, proper discharge record regarding medications and understanding about their medication in outpatients. ^2-3

They proved their dedicated role in critical units by providing quality of services ⁴ chronic disease ^5-7 like diabetes and life threatening diseases ^8-9 and by built up relationship with trust ¹⁰ to reduce drug cost ¹¹ by facing challenging task ¹² and by reducing their duration of stay in hospital ¹³ and by collaborative role with physician based on scientific evidence and pharmacy care planes ^14-17.

Various studies support role of clinical pharmacy in reducing economical burden with improvement in outcomes.^18-24 In such studies they demonstrated role of services of clinical pharmacy in diverse healthcare settings inclusive of critical care, ambulatory care, old and deliberate peoples, psychological therapeutic compliance, economical burdens and quality of healthcare issues and useful interventions ^25-28. Currently two medicinal institutes emphasized that safe utilization of medication can made possible by inclusion of pharmacist by important interventions in critical areas, safe delivery of drug in collaboration with physician and pharmacist ^29-30. Current studies showed 30% raise in percentage of pharmacist round in hospital with growing rate day by day ³¹.Various literature reviews support efficient role of clinical pharmacist in improving the health quality in inpatient care system proposed by institute of medicine in significance of clinical pharmacist role in patient setting ³² by advancing patient care, clinical pharmacist must be fundamental part of hospitalized patient care team, one study reveals services provided by clinical pharmacy showed improvement in cost of drug, medications error with decline in mortality rate ^33-35. Clinical pharmacist role distinguish remarkably from usually common classical pharmacists in such manner that they imparts their distinctive role in collaboration directly with health care practitioners and patients and not only related to drug dispensing. Most of clinical pharmacists have been trained in specialties areas of oncology, psychology, pharmacotherapy, nutrition with residencies ³⁶.

The objective of the study is to revolutionized globally with emerging role of clinical pharmacist in view of that fact that clinical pharmacist are integral part of healthcare team and serve as important tool in patient care with trust over other health care providers.

Methodology:

This retrospective study was conducted from July 2014 to Dec 2014 in major healthcare centers of Karachi particularly of patients with chronic & immune compromised diseases. Study design was conducted on 300 patients (n = 300) with well demonstrated and efficient role of clinical pharmacist towards patients care. All patients were always receiving medications with proper counseling from pharmacy and ambulatory care was being ever supported by pharmacy.

Retrospective study comprised of two important sessions, first was extra communication of clinical pharmacist with patients in separate especial built area of pharmacy to communicate well with patients about their experience with medications and compliance associated with their life saving medications to treat chronic illness. Second part was profound interaction of clinical pharmacist with consultants at ICU and how clinical pharmacist built their role over other healthcare provider with scientific evidence based knowledge of research.

Results & Statistical Analysis:

During patient interaction with clinical pharmacist disclose many horrible facts about all of which physicians were not aware. Most of the patients with blood disorders of chronic illness reported that they don’t take medications because of non-compliance, unpleasurable test and adverse effect and psychological stress associated with this drug. They have no idea that how these drugs were essential in extending life expectancy and how they may save their life. They had lost hope for life and they didn’t share this important fact with physician and how this all procedure may painful for them to take medications and treatment for life time

Clinical pharmacist were directed to pay extra attention in patient counseling and try to find out failure of results of treatment from long time and why physician couldn’t yet able to achieve target benefit to increase their life expectancy. Most of patients reported complaint associated with ADR and physicians failed to encounter such problems had ultimately lost their adherence with long term medications. Fig. 1 & Table reveals some facts of failure of achieving target with their medication to treat their chronic illness.

FIG.1: BASIS OF FAILURE OUTPUT OF TREATMENT FROM PATIENTS

After finding basis of failure of treatment, they designed study to achieve their target and responsibility purely governed by clinical pharmacist that they will prove how they are important in healthcare sector to save patient life. After proper counseling and effective communication clinical pharmacist suggested other options to take medications and how re-adherence of medication is necessary to increase life expectancy. Effective communication proved to be only way to aware patients about importance of their medication and by the suggestion of clinical they shifted to other route of administration to raise compliance also proved beneficial and patient back to their treatment and ultimately they did faith over clinical pharmacist that they are only person in healthcare sector who can understand our problems.

Interesting part of study was that patient wait for meeting with clinical pharmacist to communicate with them as they had built their trust over pharmacist.  Fig. 2 shows level of success in sixth month after effective role of clinical pharmacist. After successful communication of clinical pharmacist with patients, they also pay their attention at intensive care unit to built effective communication with physicians to find out the possible mechanism of ineffective utilization of drugs and found that due to sound knowledge of drugs clinical pharmacist may serve as useful key element in patient healthcare particularly of patient with chronic illness.

FIG. 2: LEVEL OF SUCCESS AFTER EFFECTIVE CLINICAL PHARMACIST ROLE

Clinical pharmacist also achieved target to communicate well with physician just for being providing quality of care to patient and serve as key part of effective healthcare provider.  By the scientific research and evidences they tried to put their effort in reducing adverse drug reaction and minimize the incidence of drug interaction and provide cost effective formulary for hospital with quality care. This effective role of clinical pharmacists was well appreciated by physicians and other healthcare team at intensive care unit. Fig. 3 explained an effective clinical pharmacist role can be helpful in increasing quality of health.

FIG.3: EFFECTIVE ROLE OF CLINICAL PHARMACIST

DISCUSSION: Prevalence of immunodeficient patients have increased markedly in last two decades as a resultant of  lose in immunity either may be as a progression of disease or due to foreign agent that make prone to body for development of opportunistic infection. Patient with chronic illness require special care because of weak immune system and serious adverse reaction associated with life saving drugs, as they put their life on risk seriously due to reduction in compliance day by day as a result of non-adherence with treatment.

Pharmacist are the integral part of healthcare team they provide patient care by reducing medication error, by evaluating failure of treatment, by dispense drug safely especially narcotic analgesic , and prove their role essential for health society ^37-39. Traditionally the prescribing of drug and rational goal therapy responsibility is governed by physician only but current studies showed clinical pharmacist are also integral part of healthcare system with well demonstrated role in patient compliance, drug related ADR and patient lost of hope due to their chronic illness by their proper counseling by pharmacist. With amelioration in current era of cure of serious illness, collaborative role of healthcare team is necessary with special consideration in view of the fact to achieve useful outcome in patient with serious illness and to reduce economical burden.

This studies showed that Clinical Pharmacist may serve as integral part in building of effective healthcare team with well interesting finding that patient do more trust on pharmacist compared to other healthcare providers. They assume that clinical pharmacist was the only key person that can understand their problem and helpful in solving their psychological burden associated with their chronic illness and long term use of medications.

Pharmacist intervention made at intensive care unit also showed gradual decline in medication error and consultation of pharmacist proved to be economic in cost of drug. However, inclusion of pharmacist in patient care with other healthcare provider at intensive care unit showed reduction in adverse reaction and also acknowledge by physician readily ⁴⁰.

Current study is conducted to evaluate the basis of failure of treatment in patient with chronic illness. Incorporation of clinical pharmacist in collaboration with other healthcare team may play a dynamic role in improving quality of health.

CONCLUSION: Clinical pharmacists are integral part of healthcare sector, imparts effective role in patient care, in collaboration with other member of health care team. They tend to serve as key element in achieving successful outcome of treatment by effective communication, by built trust and by effective counseling with patient. A pharmacist intervention with physician during round is useful tool in minimizing ADR and cost effectiveness. Further research is necessary to make role of clinical pharmacist evident in healthcare sector and society towards patient care.

More detail study with research is needed to compute the evident role of pharmacist to healthcare sector to isolate the worth of pharmacist in healthcare system.

ACKNOWLEDGMENT: Authors wish to acknowledge Rabia Arshad (pharmacist) for her help and support in this study.

REFERENCES:

1. Hossein Khalili, Shadi Farsaei, Haleh Rezaee, Simin Dashti-Khavidaki: Role of clinical pharmacists’ interventions in detection and prevention of medication errors in a medical ward. Int J Clin Pharm (2011) 33:281–284
2. Michael Farley, Constance Shelsky, Shanique Powell, Karen B. Farris, Barry L. Carter: Effect of Clinical Pharmacist Intervention on Medication Discrepancies Following Hospital Discharge. Int J Clin Pharm, 2014 Apr; 36(2): 430–437.
3. Peter Loewen: Pharmacists’ perceptions of the impact of care they provide. Pharm Pract (Granada). 2010 Apr-Jun; 8(2): 89–95.
4. Suzan N. Kucukarslan, PhD,Kim Corpus, PharmD, Nisha Mehta, PharmD, Mark Mlynarek, PharmD, Mike Peters, BS Pharm, Lisa Stagner, DO andChris Zimmerman, PharmD : Evaluation of a Dedicated Pharmacist Staffing Model in the Medical Intensive Care Unit. Hosp Pharm. 2013 Dec; 48(11): 922–930.
5. Lisa Zhu, Andrea Fox, and Yu Chun Chan: Enhancing Collaborative Pharmaceutical Care for Patients with Chronic Kidney Disease: Survey of Community Pharmacists. Can J Hosp Pharm. 2014 Jul-Aug; 67(4): 268–273.
6. Stemer G,Lemmens-Gruber R : Clinical pharmacy activities in chronic kidney disease and end-stage renal disease patients: a systematic literature review. BMC Nephrol. 2011 Jul 22; 12:35. Doi: 10.1186/1471-2369-12-35.
7. Salgado TM¹,Correr CJ, Moles R, Benrimoj SI, Fernandez-Llimos F : Assessing the implementability of clinical pharmacist interventions in patients with chronic kidney disease: an analysis of systematic reviews. Ann Pharmacother. 2013 Nov; 47(11):1498-506. Doi: 10.1177/1060028013501802. Epub 2013 Sep 27.
8. Thomas M. Henry, PharmD, BCPS,Steven Smith, MS, RPh, BCACP, and Michael Hicho, PharmD Candidate: Treat to Goal: Impact of Clinical Pharmacist Referral Service Primarily in Diabetes Management. Hosp Pharm. 2013 Sep; 48(8): 656–661.
9. Junling Wang, Ph.D.,Lindsay J. Ford, Pharm.D., La’Marcus Wingate, Pharm.D., Ph.D., Sarah Frank Uroza, Pharm.D., Nina Jaber, Pharm.D., Cindy T. Smith, Pharm.D., BCPS, Richard Randolph, Pharm.D., Steve Lane, Pharm.D., and Stephan L. Foster, Pharm.D., FAPHA : The Effect of Pharmacist Intervention on Herpes Zoster Vaccination in Community Pharmacies. J Am Pharm Assoc (2003) 2013; 53:46-53. doi:10.1331/JAPhA.2013.12019
10. Julie C. Lauffenburger, Maihan B. Vu, Jena Ivey Burkhart, Morris Weinberger, Mary T. Roth: Design of a medication management program for Medicare beneficiaries: Qualitative findings from patients and physicians. Am J Geriatr Pharmacother. 2012 April ; 10(2): 129–138. doi:10.1016/j.amjopharm.2012.01.002.
11. Hai-Xia Zhang,Xin Li, Hai-Qin Huo, Pei Liang, Jin-Ping Zhang, and Wei-Hong Ge : Pharmacist Interventions for Prophylactic Antibiotic Use in Urological Inpatients Undergoing Clean or Clean-Contaminated Operations in a Chinese Hospital. 2014 Feb 25. doi:  1371/journal. pone.0088971.
12. Sandra A N Walker, Jennifer K Lo, Sara Compani, Emily Ko, Minh-Hien Le, Romina Marchesano, Rimona Natanson, Rahim Pradhan, Grace Rzyczniak, Vincent Teo, and Anju Vyas: Identifying Barriers to Medication Discharge Counselling by Pharmacists. Can J Hosp Pharm. 2014 May-Jun; 67(3): 203–212.
13. Chuan Zhang,Lingli Zhang, Liang Huang, Rong Luo, and Jin Wen : Clinical Pharmacists on Medical Care of Pediatric Inpatients: A Single-Center Randomized Controlled Trial. PLoS One. 2012; 7(1): e30856
14. Ho K¹,Nguyen A, Jarvis-Selinger S, Novak Lauscher H, Cressman C, Zibrik L : Technology-enabled academic detailing: computer-mediated education between pharmacists and physicians for evidence-based prescribing. Int J Med Inform. 2013 Sep; 82(9):762-71. Doi: 10.1016/j.ijmedinf.2013.04.011. Epub 2013 Jun 14.
15. David E. DeMik, Pharm.D.,Mark W. Vander Weg, Ph.D., Emily S. Lundt, M.S., Christopher S. Coffey, Ph.D., Gail Ardery, Ph.D., and Barry L. Carter : Using theory to predict implementation of a physician–pharmacist collaborative intervention within a practice-based research network. Res Social Adm Pharm. 2013 Nov-Dec; 9(6): 10.1016/j.sapharm.2013.01.003
16. Makowsky MJ¹,Madill HM, Schindel TJ, Tsuyuki RT : Physician perspectives on collaborative working relationships with team-based hospital pharmacists in the inpatient medicine setting. Int J Pharm Pract. 2013 Apr; 21(2):123-7. Doi: 10.1111/j.2042-7174.2012.00227.x. Epub 2012 Jul 31.
17. Zaher Al Salmi : Clinical Audit of Pharmaceutical Care provided by a Clinical Pharmacist in Cardiology and Infectious Disease in-patients at the Royal Hospital, Muscat/Oman : Oman Med J. 2009 Apr; 24(2): 89–94.
18. Bond CA, Raehl CL, Franke T. Interrelationships among mortality rates, drug costs, total cost of care, and length of stay in United States hospitals: summary and recommendations for clinical pharmacy services and staffing. 2001; 21(2):129–141.
19. Brown BK, Earnhart J. Pharmacists and their effectiveness in ensuring the appropriateness of the chronic medication regimens of geriatric inpatients.Consult Pharm. 2004; 19(5):432–436.
20. Gillespie U, Alassaad A, Henrohn D, et al. A comprehensive pharmacist intervention to reduce morbidity in patients 80 years or older: a randomized controlled trial. Arch Intern Med. 2009; 169(9):894–900.
21. Spinewine A, Swine C, Dhillon S, et al. Effect of a collaborative approach on the quality of prescribing for geriatric inpatients: a randomized, controlled trial.J Am Geriatr Soc. 2007; 55(5):658–665.
22. Kaboli PJ, Hoth AB, McClimon BJ, Schnipper JL. Clinical pharmacists and inpatient medical care: a systematic review.Arch Intern Med. 2006; 166(9):955–964.
23. Kucukarslan SN, Peters M, Mlynarek M, Nafziger DA. Pharmacists on rounding teams reduce preventable adverse drug events in hospital general medicine units. Arch Intern Med. 2003; 163(17):2014–2018.
24. Holland R, Lenaghan E, Harvey I, et al. Does home based medication review keep older people out of hospital? The HOMER randomised controlled trial. 2005; 330(7486):293.
25. Beney JBero LA Bond C expanding the roles of outpatient pharmacists: effects on health services utilization, costs, and patient outcomes. Cochrane Database Syst Rev2000; CD000336
26. Kane SL Weber RJ Dasta JF The impact of critical care pharmacists on enhancing patient outcomes. Intensive Care Med2003;29691- 698
27. Wachter RM Goldman L The hospitalist movement 5 years later. JAMA2002; 287487- 494

28. Keely JL American College of Physicians–American Society of Internal Medicine, Pharmacist scope of practice. Ann Intern Med2002;13679- 85
29. Academic Health Centers, Leading Change in the 21st Century. Washington, DC National Academy Press2003.
30. Kohn LT Corrigan JM Donaldson MS To Err Is Human. Washington, DC National Academy Press2000.
31. Pedersen CA Schneider PJ Santell JP ASHP national survey of pharmacy practice in hospital settings: prescribing and transcribing–2001. Am J Health Syst Pharm2001; 582251- 2266.
32. Crossing the Quality Chasm:A New Health System for the 21st Century.  Washington, DC National Academy Press2001;
33. Joint Commission on Accreditation of Healthcare Organizations, 2005 National hospitals' patient safety goals.
34. Bond CA Raehl CLFranke T Interrelationships among mortality rates, drug costs, total cost of care, and length of stay in United States hospitals: summary and recommendations for clinical pharmacy services and staffing. Pharmacotherapy2001;21129- 141
35. Bond CA Raehl CL Franke T Clinical pharmacy services, hospital pharmacy staffing, and medication errors in United States hospitals. Pharmacotherapy2002; 22134- 147
36. Peter J. Kaboli, MD, MS; Angela B. Hoth, Pharm D; Brad J. McClimon, MD, PharmD; Jeffrey L. Schnipper, MD, MPH, Clinical Pharmacists and Inpatient Medical Care A Systematic Review ,Arch Intern Med. 2006;166(9):955-964. doi:10.1001/archinte.166.9.955.
37. Kahan, Meldon et al. “Pharmacists’ Experiences with Dispensing Opioids: Provincial Survey.” Canadian Family Physician 57.11 (2011): e448–e454
38. Mysak TM, Rodrigue C, Xu J. Care Providers’ Satisfaction with Restructured Clinical Pharmacy Services in a Tertiary Care Teaching Hospital. The Canadian Journal of Hospital Pharmacy.2010; 63(2):105-112.
39. Meyer LD, Raymond CB, Rodrigue CMJ. Development and Evaluation of a Checklist for Medication Order Review by Pharmacists. The Canadian Journal of Hospital Pharmacy. 2011; 64(3):199-206.
40. Klopotowska JE, Kuiper R, van Kan HJ, et al. On-ward participation of a hospital pharmacist in a Dutch intensive care unit reduces prescribing errors and related patient harm: an intervention study. Critical Care. 2010; 14(5):R174. Doi: 10.1186/cc9278.
    

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How to cite this article:

Ayub M, Gul S, Afzal N and Eraj A: An effective clinical pharmacist communication may built patient trust on pharmacist over other healthcare providers: evidence based practice. Int J Pharm Sci Res 2015; 6(10): 4442-47.doi: 10.13040/IJPSR.0975-8232.6(10).4442-47.

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