Engaging Patients: Characteristics and Qualities Patients Seek of Their Pharmacists….
Throughout history, people have looked upon others to be “good”—good neighbors, good coworkers, good teachers, good friends, and, in general, good people. To link the term “good” to pharmacy, we must be aware that past and present remedies (medications) can do good or cause harm. Of course, this depends on whose hands the remedy (medication) is in—a knowledgeable person who wants to do good, or someone who means to do harm. Evidence-based quality and outcomes were not a key component of medication use even a few decades ago. This has changed with the continued growth of healthcare and the pharmacy profession.
Today when we look at healthcare, we see scorecards for process management, research, outcomes, funding, success rates for procedures, STAR ratings, and numerous other areas that are evaluated, assessed, and reviewed. However, it seems that 2 areas have been left out—the specific needs of the individual patient, and the quality and attributes of a “good” healthcare provider.
“He is a good pharmacist” or “she is a good pharmacist” is a commonly heard phrase. Those compliments lift that pharmacist above other pharmacists. However, a question arises as to what this actually means. Historically, the qualities and characteristics of a “good pharmacist” have remained obscure, especially when looking at this from the patient perspective.
Knowing what patients are looking for in a “good pharmacist” can help practicing pharmacists become better practitioners. Understanding this patient need can help us move the profession toward a visible patient-centered model where the patient (or caregiver) is fully engaged in all aspects of medication-related care, including prescriptions, over-the-counter medications, vitamins, herbals, and preventive care such as vaccinations.
Patient-centered care ensures that the transitions of care are coordinated, efficient, respectful, and also take into consideration the patient’s personal preferences and values.1 The Institute of Medicine (IOM) made visible patient-centered care 1 of 6 domains of quality. According to the IOM, “research shows that orienting the health system around the preferences and needs of patients has the potential to improve patients’ satisfaction with care as well as their clinical outcomes.”2 The key question is how we apply this model in a community setting.
A few years ago, a community pharmacy study asked patients what they expected of their pharmacist.3 The result was disappointing—most patients did not have an answer. After providing the patients with a list of possibilities, the top patient expectations of pharmacists were to: (1) fill the prescription correctly; (2) uphold confidentiality; (3) check for correct dosage; (4) check for drug interactions; and (5) check for drug allergies (most items that are now done with technology). Of the patients who responded, 94% said that it was important or very important that pharmacists showed that they cared about them. However, only 40% of the patients and 50% of the pharmacists queried felt that they had a close relationship with each other.
In the past few years, we have seen great progress in the expansion of our pharmaceutical care role in the community setting. Clinical services such as medication therapy management, vaccinations, healthcare screening, and disease-based programs are becoming more common. However, for this to become more of a standard of practice, the profession will require that each pharmacist assume even greater responsibility for their patients’ outcomes and to establish a meaningful communication exchange to help their patients make informed decisions and adhere to the appropriate therapy.
Characteristics of a Good Pharmacist:
In a more recent study, in 2011, patients, physicians, nurses, and pharmacists were asked a series of open-ended questions about what qualities make a “good pharmacist.”4 The information gathered began to form a baseline of characteristics, virtues, and qualities that patients and others seek to find in a good pharmacist. The remainder of this article will discuss the highlights of this study, focusing on the patients’ thoughts and comments regarding important qualities and characteristics that allow a pharmacist to have the greatest impact on the lives of their patients. Table 1 lists the top 5 characteristics that patients said are personally important to them.
Being knowledgeable is, of course, central to our profession. Our education and continued learning are part of the covenant that we have with our patients. However, knowledge alone is not the key. Being knowledgeable but not having any of the other characteristics would not provide the basis for the sound relationship that patients are seeking to have with a good pharmacist. Patients described “caring” as an essential ingredient in building an effective therapeutic alliance with them. However, one question that needs to be asked is whether we even consider measuring caring as a component of quality clinical services? If one looks at the list in Table 1 and pulls out the behavioral-related areas of “caring,” “attentive,” and “being friendly,” we can begin to see what a patient is looking for to be more engaged with us in their own healthcare. While we still have issues of patients who want their medication fast and are in a hurry, we need to consider that these patients do not understand the services that we provide, nor have they been exposed to or provided the characteristics they are seeking. The characteristics identified are central to our moving forward with hiring, training, and professional development of future community-based “good pharmacists.”
Qualities of a Good Pharmacist:
While the characteristics help us to understand some aspects of what patients are looking for in an individual pharmacist, there are broader qualities that patients seek. the qualities that all groups (patients, physicians, nurses, and pharmacists) indicate are critical to engaging patients in a patient-centered care process.
Patients provided information across a wide variety of terms that they listed in the open-ended questions. From a qualitative perspective, the list in Table 2 is a compilation of the terms that were used related to a pharmacist who they categorized as a good pharmacist.
For example, an Expert is someone who is knowledgeable, smart, clinically competent, and provides evidence-based care. Patients were not looking for a walking medical dictionary, nor were they looking for someone who can just read directions on a bottle or the medication guide. Patients are looking for an expert to communicate information in a way they can understand and apply to their medication and how this will impact their health.
A Professional is someone who collaborates with others, takes a leadership role in patient advocacy, and has high integrity. Of interest is the additional emphasis that the “patient comes first.” It also makes sense that patients look for someone with a solid work ethic—someone who is hard-working, detail-oriented, accurate, and results-oriented (clinical outcomes). The good pharmacist has a strong moral character and displays honesty, takes responsibility for the patient’s medication/pharmacy care, is mature, and is supportive of questions through the information-giving process to meet the patient’s needs and preferences.
Finally, a pharmacist who practices with a patient-oriented (ie, being patient centric) focus is approachable, responsive, and readily available to come out from behind the counter and counsel not only when the patient asks but also proactively to determine how the patient’s pharmaceutical care is progressing. The pharmacist needs to provide this not only on the first fill but also on refills of chronic medications and concerns when acute medications are added.
Visible Patient-Centered Care:
A pharmacist who is practicing in an environment that supports visible patient-centered care makes the patient the central focus. Pharmacists can provide this visible care by being friendly and attentive, showing that he or she cares, takes patient diversity into account, and considers the patient’s perspective by placing emphasis on patient participation and decision options. Being patient-centric is putting the patient first—being 100% focused on the patient during the counseling process or when they call for follow-up questions.
Patients who experience care from a good pharmacist are more inclined to be a patient engaged in the relationship who seeks out the pharmacist to provide more than just the medication. These “good pharmacists” are practicing at the top of their license, not only providing the most up-to-date knowledge, but providing this knowledge in a genuine patient-centered care process that is attentive to the patient’s needs. They are caring and friendly, and they proactively take responsibility for their patients.
The patients who receive patient-centered care perceive the value of the care they receive and are not concerned if they have to wait a few extra minutes because they know that the pharmacist will be completely focused on them at the time they provide counseling. They understand that the pharmacist is looking out for them even at times when they are not getting a prescription.
Future “good pharmacists” are what the profession needs to become a true clinical profession, to be recognized as a true healthcare provider, and to receive reimbursement for making a difference in patient care, quality services, and positive evidence-based, clinical-based outcomes.
Institute for Healthcare Improvement. Across the Chasm Aim #3: Health Care Must Be Patient-Centered. www.ihi.org/knowledge/Pages/ImprovementStories/AcrosstheChasmAim3HealthCareMustBePatientCentered.aspx. Accessed June 25, 2013.
Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. www.iom.edu/~/media/Files/Report%20Files/2001/Crossing-the-Quality-Chasm/Quality%20Chasm%202001%20%20report%20brief.pdf. Accessed June 25, 2013.
Smith LL, Kramer SV, Kelly WN. Are pharmacists’ and patients’ expectations of each other the same? Georgia Pharmacy J. 2004:20-22.
Kelly WK, Sogol EM, eds. The Good Pharmacist: Characteristics, Virtues, and Habits. Oldsmar, FL: William N. Kelly Consulting Inc; 2011.