Meeting Pharmacy Patients’ Needs

Meeting Pharmacy Patients’ Needs


In almost every clinical setting across the Nation, health care professionals face scenarios where patients with different cultures, different family histories, and different beliefs come to get medical help. For each of them, culture plays a large role in shaping their health values, beliefs, behaviors, and choices. So, how does a health care professional recognize a patient’s specific need?

In early studies, understanding of patient needs started with the assumption that providers know the needs of the patients, based on professional standards and their own experiences (1). In recent years, however, a number of patient-focused studies have clearly identified a much wider range of patient needs (2).


Meeting The Need (3)


Pharmacists and their Pharmacy Technicians (who function as their assistants) need to ensure that people can access medicine or pharmaceutical advice easily and, as far as possible, in a way and at a time and place of their own choosing. They can empower patients by engaging them in dialogue to communicate knowledge that enables them to manage their own health and treatment. Although patients are exposed to a wide range of information from package inserts, promotional materials, advertising in the media and through the internet, this information is not always accurate or complete. The pharmacist and their assistants can help ‘informed’ patients become ‘accurately informed’ patients by offering unbiased and relevant evidence-based information and by pointing to reliable sources. Counseling on disease prevention and lifestyle modification will promote public health, while shared decision-making on how to take medicines through a concordant approach will optimize health outcomes, reduce the number of medicine-related adverse events, cut the amount of medicine which is wasted and improve adherence to medical treatment.


In 2000, a publication by the UK Department of Health entitled “Pharmacy In The Future”set out the requirement for structured professional support to be provided by pharmacists, to improve and extend the range of pharmacy services available to patients, including identification of the individual’s pharmaceutical needs (plus in-depth insight into patients’ backgrounds—to be discussed in later pages), development of partnerships in medicine-taking, coordination of repeat prescribing and dispensing processes, targeted treatment review and follow-up. A new contractual framework for community pharmacy is being implemented that is key to delivering the vision of primary care in the future. This new community pharmacy contract will enable reorientation of services to meet patient expectations and maximize pharmacist potential to deploy their skills to better effect. The pharmacy contract provides for categorization into essential, advanced and enhanced pharmacy services with a focus on quality and outcome in all cases.


One example of a disease that shows the level of care and prevention services that pharmacists and technicians provide is HIV/AIDS. Pre-service and ongoing training of pharmacists and technicians in providing HIV/AIDS prevention, care and treatment is essential. The content and delivering of training for pharmacists in particular will depend on their allocated roles and responsibilities. Since pharmacists’ knowledge, attitudes, and behavior influence the way in which HIV care, treatment and prevention services are delivered and used, adherence to chronic HIV/AIDS care and treatment (especially the provision of antiretroviral therapy) is one of the key areas where pharmacists need to be involved.


In 2004, FIP launched an International Network for Pharmacists on HIV/AIDS ( which focuses on three areas: training, documentation, and exchange of experience. It includes training modules, policy documents, useful publications, links to national and international organizations, an events calendar to which additional events can be added, and a mailing list to allow pharmacists and others in that field throughout the world working in the field of HIV/AIDS and will help pharmacists to become leaders in the fight against the pandemic.


The Approach to the Delivery of Pharmaceutical Care


Step 1: Assess needs and identify drug problems

Step 2: Develop a care plan

Step 3: Implement a care plan

Step 4: Monitor and review the care plan



Dealing with Patients of Different Cultures (4)


Currently, an educational movement referred to as “cultural and linguistic competence” has emerged, with the goal of providing health care professionals with the knowledge and skills to manage these “cross-cultural” challenges effectively in the clinical encounter. This field is in fact not new, yet has been re-energized over the last ten years with pronouncements by the Institute of Medicine, American Medical Association, and the American Nursing Association, among others, that cultural and linguistic competence is necessary for the effective delivery of health care in the United States.

A primer, developed under the direction of Joseph R. Betancourt, MD, MPH, and the Culturally Competent Care Education Committee (CCCEC) at the Harvard Medical School (HMS) says health car eprofessionals should follow four steps when caring for all patients, but in particular those patients who are from a social or cultural background different from that of the care provider. Clinicians should think of these four steps as a “review of systems” focused on issues that, if not addressed, may lead to poor health outcomes. The four steps are:

Step 1—Identify the Core Cross-Cultural Issues.

Styles of communication: How does the patient communicate? Communication includes issues relating to: eye contact, physical contact, and personal space; and issues about how the patient may prefer to hear “bad news.” For example, is the patient deferential or confrontational? Does the patient display stoicism or express symptoms willingly?
Mistrust and prejudice: Does the patient mistrust the health care system? If so, health care professionals should recognize prejudice and its effects and attempt to build trust by reassuring the patient of one’s intentions. Keep in perspective “what’s at stake” for the patient, and show respect for the patient’s concerns.
Autonomy, authority, and family dynamics: How does the patient make decisions? What is the role of the family versus the individual in decision making? What support does the patient have from his or her family of origin, partner, and friends? What is the role of the authority figure within the family or social group? What role does community or spiritual leaders play in important decisions?
The role of the practitioner and biomedicine: What does the patient expect of clinicians and what is the clinician’s role? What are the patients’ expectations for the practitioner and biomedicine? What perspectives does the patient have about the practitioner? Does the patient consider the clinician to be a service provider or gatekeeper, for example? What are the patient’s views on alternative medicine versus biomedicine?
Traditions, customs and spirituality: How do these factors influence the patient? These attitudes include issues regarding medical procedures, such as drawing blood, and rituals pertinent to the medical encounter. What culturally specific “alternative” therapies does the patient consider, including culturally specific diet and preferences?
Sexual and gender issues: How central are these issues to the patient’s life? Is there gender concordance or discordance? What attitudes does the patient have toward the physical exam and the gender of the practitioner? Health care professionals should use the preferred pronoun for patients who are transgender or transsexual and consider the issue of shame or embarrassment when discussing sexual issues. Consider also the differences in sexual behavior, orientation, and identity.
Step 2—Explore the Meaning of the Illness. Health care providers can make such determinations by asking the patient the following questions:

What do you think has caused your problem? How?
Why do you think it started when it did?
How does it affect you?
What worries you most: the severity of the condition, or duration of the illness, or both?
What kind of treatment do you think you should receive? What expectations do you have?
Step 3—Determine the Social Context. The “social context” is of equal importance as an area of exploration, given how social and cultural factors are intertwined. Certain key areas should be considered when identifying the patient’s social context:

Tension (social stress and support systems): Does the patient have social support, or is he or she isolated?
Environment change (degree and reason for change, expectations, and acculturation): What was the patient’s previous health care experience, and how does that experience shape his or her interaction with the health care system now?
Life control (including social status, poverty, and education): What resources does the patient have? Can he or she afford medications?
Literacy and language: Does the patient have limited English proficiency or literacy, and how does such a limit affect his or her health care?
Step 4—Negotiate. Such negotiation requires exploring the meaning of the illness for the patient and formulating a mutually acceptable plan.

When the health care professional is caring for a patient with limited or no English proficiency, securing an interpreter is critical. If you can not find a trained interpreter, a casual or ad-hoc interpreter, which could be a co-worker or family member, can be used. And then:
Recognize the importance of the perspective of the family member or friend, get that perspective, and then emphasize the importance of getting as much information as possible directly from the patient
Trust one’s senses: If the responses seem inadequately translated, or the history is confusing, insist on getting a trained interpreter
Keep in mind that when using a family member or friend, there may be significant issues involving confidentiality and accuracy, which could embarrass the patient, and so using an ad hoc interpreter might be ill-advised. Additionally, when domestic violence is involved or suspected, do not use spouses or partners as interpreters. In such cases, what may seem routine may not be true, and so a neutral person would be most effective as an interpreter in such situations.




















1. Merkouris A, et al (1999). Patient satisfaction: A key concept for

evaluating and improving nursing services. J Nurs Manage 7, 19-28.


2. Bader, MM (1988). Nursing care behaviors that predict patient

satisfaction. J Nursing Qual 2(3), 11-17.


3. Wiedenmeyer, K., Summers, R.S., Mackie C.A., Gous, A.G., Everard, M.

(2006). Developing pharmacy practice: a focus on patient care. World Health

Organization & International Pharmaceutical Federation 1, 1-9.


4.Campinha,-Bacote, J., Claymore-Cuny, P., Cora-Bramble, D., Gilbert, J.,

Husbands, R., Like, R. C., et al (2005). Transforming the face of health

professions through cultural and linguistic competence Education. Health

Resources and Services Administration 5. Retrieved April 12, 2007, from


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