Chapter 1
Instructor’s Manual
Answers to Review Questions
1. What is patient-centered care?
Patient-centered care is a concept that places the focus of pharmacy practice on meeting
the needs of patients rather than the needs of the pharmacists or the pharmacy. It is easy
to concentrate on the administrative and dispensing aspects of pharmacy practice,
especially in a busy community or institutional environment (i.e., how many prescriptions
will we fill today, how to get medication orders up to the floors). This chapter describes
how to refocus attention from a task orientation to a more patient-focused orientation in
order to provide better patient care. Patient-centered practice recognizes that certain
tasks must be performed by pharmacy staff, but these tasks should be targeted at
providing better care for patients and not just making the life of the pharmacy staff easier
or the pharmacy department more efficient. (pp. 2–3)
2. What are the two primary functions that the communication process serves between health
professionals and patients?
a) Communication helps establish ongoing relationships between health care providers
and their patients. Without effective communication skills, practitioners have difficulty
establishing rapport with their patients, which is essential if patients are to feel
comfortable interacting with providers and disclosing personal information.
b) Communication also provides the mechanism to exchange critical information to
assess patient health conditions, to reach decisions on treatment plans, to implement
these plans, and to evaluate the effects of treatment on the patient’s quality of life. The
constant flow of essential information between patient and provider is enhanced by
effective communication skills. (p. 3)
Pharmacy technicians often have a lot of direct interactions with patients (in the
community pharmacy practice setting) and therefore are an ideal intermediary between
patients and other members of the health care team including pharmacists.
3. What is the benefit of analyzing the medication-use process by patients?
The key here is to monitor whether your patients are using their medications correctly
and, if not, to identify possible reasons for this behavior. As stated in Chapter 1 as well
as other chapters, medication adherence rates are less than optimal, resulting in
increased hospitalization and emergency room and physician office visits. Effective
communication provides an opportunity for you to probe for possible reasons of
nonadherence and to structure possible strategies working with your patients to
overcome difficulties in taking medications correctly. An important step is to get patients
more involved with their health care decision making. (pp. 5–8)
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A good follow-up question for classroom discussion would be, “What are some specific
ways to improve medication adherence?”
Discussion of Review Cases
Review Case 1.1 (p. 10)
A family who often comes to your pharmacy is facing a devastating situation. The husband lost
his minimum-wage job. They were evicted from their apartment, have no extended family to turn
to for help, and have a child with asthma who requires medications and ongoing care. The child
got a new prescription for a Flovent HFA (1 puff BID) inhaler and Proventil HFA (1–2 puffs prn
q4–6 hours) that the family cannot afford.
1. What sources of assistance are available in your community for the housing needs of such a
family?
2. What sources of assistance are available for the medical and prescription needs?
Editors’ Commentary
Available assistance will vary from location to location, but most communities have
housing offices that pharmacists can refer needy patients to. Places of worship (churches,
temples, etc.) and the Red Cross/Salvation Army typically have some ideas.
In regards to medications, probing for additional information in a concerned manner
may help to identify specific issues. For example, did the patient discuss the use of
generic or lower, less expensive tier medications with the physician? If access is truly an
issue, some communities have “Med-banks” that can provide or locate medication for
families. In addition, many pharmaceutical companies have their own “PAP”
(Prescription Assistance Program) to help secure needed medications for patients.
Review Case 1.2 (p. 11)
Your patient, Mr. Rowe, is a 65-year-old man who has osteoarthritis. For many years, his hips
have hurt him off and on. On days when he experienced pain, he would take one dose of 400 mg
of ibuprofen, and that managed the pain. Gradually over the years, the pain became more
frequent, and the ibuprofen did not help as much. Then his knees also began to ache when he
went on walks. He talks to you as his pharmacist about how he can manage his pain without
having to go to a physician because he does not want to start taking prescription drugs if he can
help it.
What further information would you want to obtain from Mr. Rowe that would assist you in
deciding how to be of help?
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Editors’ Commentary
Most pharmacists would probe for additional information regarding the pain; many
would perform a “pain analysis” to assess the severity, frequency, and possible causes of
the pain. The key is not to offer a “quick fix” and just deal with the current issue,
disregarding future ramifications of the pain.
At this point, it would be important to remind pharmacy technicians that they need to
refer questions requiring professional judgment to the pharmacist.
Supplemental Exercise
The following scenario could be used to emphasize where a pharmacy technician could fit in
with respect to assisting the pharmacist with communication between patients and pharmacists.
Scenario Title: If Only…
Characters:
Narrator
Lilly
Steve
Thoughts
Mrs. Phillips
Background:
The following scenario occurred on an ordinary day at a local community pharmacy. Lilly, the
pharmacy technician, was waiting on Mrs. Phillips, an elderly customer, as she picked up her
refill. Steve, the pharmacist, was checking other prescriptions.
[Lilly’s unspoken thoughts are italicized and set off by brackets.]
Mrs. Phillips: “Can I pick up my medication, please? My name is Anna Phillips.”
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Lilly: (Lilly retrieves Mrs. Phillips’ prescription from the rack and scans it into the register.)
“You have just one prescription today. Your total comes to $8.00.”
Mrs. Phillips: (Mrs. Phillips removes money from her purse and hands Lilly $8.00.) “Here you
go honey.”
Lilly: “Thank you. Do you have any questions for the pharmacist, Mrs. Phillips?”
Mrs. Phillips: “No, but do you know what? I'm feeling okay using these pills, but at nighttime, I
keep getting up to pass water. Up and down. Up and down. I'm usually up five or six times a
night.”
Steve: (Steve overhears Mrs. Phillips’ comments and walks over to the pick-up counter.) “Mrs.
Phillips, you said you were getting up many times a night to use the restroom?”
Mrs. Phillips: “That's right. I make sure I don’t drink any liquids before I go to bed. I only drink
a tiny bit of water with this pill at bedtime.”
(While Steve and Mrs. Phillips are talking, Lilly peeks at the medication in the bag that Mrs.
Phillips is picking up. It is Diovan HCT.)
Steve: “I'll take a look at your medication list and see if there’s anything that could be causing
this problem.”
Mrs. Phillips: “Thank you kindly, Steve. Have a nice afternoon.” (She picks up her bag and
walks away. Steve returns.)
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Lilly: [Why didn’t Steve look at her medication? If she’s taking that Diovan HCT at night, it’s no
wonder she hasn’t drowned yet. He made it seem like it was no big deal. If only I had spoken up.]
Post-scenario questions for classroom discussion:
1. What happened?
2. How did unspoken thoughts and assumptions affect the interaction?
3. How did the communication strategies affect the outcome?
4. How could this have been handled differently?
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