Inka Puumalainen

Progress in patient counselling practices in Finnish community pharmacies

Objective The aim of this study was to assess progress in patient counselling practices in Finnish community pharmacies during a national four‐year program (TIPPA) from 2000–2003 promoting enhanced pharmacist‐customer communication about medicines.

Attitudes of Finnish Community Pharmacists Toward Concordance

BACKGROUND Concordance is a new model of interaction between healthcare professionals and patients. The work of pharmacists and patients in the consultation is a negotiation between equals, and the aim is therapeutic alliance between them. OBJECTIVE To assess Finnish community pharmacists’ attitudes toward concordance and its perceived impact on pharmacist–patient consultations during a 4-year Finnish project (TIPPA Project 2000–2003) aimed at promoting patient counseling. METHODS A survey of a random sample of 734 community pharmacists in Finland was conducted in 2002. The questionnaire included an attitudinal scale and 2 open-ended questions on the impact of the TIPPA Project on patient counseling. Attitudes toward concordance were measured using a modified version of the LATCon scale. The construct validity and internal consistency of the scale were evaluated using factor analysis and Cronbachs α. Mean summative factor scores (MSS) and 95% confidence intervals were calculated for each factor. The responses to the open-ended questions were content analyzed. RESULTS A response rate of 51% (n = 376) was obtained. Almost 80% of the respondents strongly agreed that the highest priority in patient counseling was to establish a therapeutic alliance between the pharmacist and patient. Factor analysis of the attitudinal scale yielded 3 primary factors explaining 37.6% of the variance, interpreted as respecting patients’ beliefs (α = 0.60; MSS = 1.90; 95% CI 2.25 to 2.40), establishing a therapeutic alliance (α = 0.65; MSS = 1.36; 95% CI 1.31 to 1.40), and sensitivity to patients’ reactions (α = 0.66; MSS = 2.33; 95% CI 1.83 to 1.96). Results of the open-ended questions indicated that the TIPPA Project had a positive impact on pharmacists’ attitudes toward concordance. CONCLUSIONS Respondents to our survey were supportive of concordance. The TIPPA Project elicited a positive impact on pharmacists’ attitudes toward counseling. Pharmacist education through programs such as TIPPA can aid in the implementation of a concordance-based counseling practice.

Practicing pharmacists' patient counseling skills in the context of reflectivity

Background: Pharmacists are expected to develop and re-evaluate their expertise in order to succeed in their working life, thus fulfilling the demands of the society. One of the tasks that has become essential in modern pharmacy practice is “reflective communication about medicines” with patients. Methods: The purpose of this study was to describe the levels of patient counseling skills of 40 Finnish community pharmacists in the context of reflectivity. The theoretical background of the study was based on United States Pharmacopeia(USP) Medication Counseling Stages and Mezirow’s theoretical underpinning. The data consisted of essays written by 40 practicing pharmacists (M.Sc. and B.Sc. Pharm.) before starting the one-year patient counseling courses in 2000 (n=2) and 2001 (n=19). The data were analysed using categorization and thematic analysis. Results: The results showed that only one pharmacist reached the level of critical consciousness. Altogether, 22 pharmacists remained at the level of affective reflectivity (the novice level of competency) and 10 remained at the level of consciousness (the beginner level of competency). With the exception of one pharmacist, they had poor understanding of the interactive role of a patient. Conclusion: New teaching methods and evaluation tools applicable to basic education, continuing education and in-house training are needed to support reflective learning process in developing professional competencies, such as patient counseling skills.

Usefulness of the USP Medication Counselling Behavior Guidelines

Objective:To assess the perceived usefulness of the United States Pharmacopeia (USP) Medication Counselling Behavior Guidelines among Finnish community pharmacists. The Guidelines were systematically disseminated to pharmacists through a 4-year project (TIPPA 2000–2003).Method:A postal questionnaire was sent to a random sample (n = 734) of Finnish community pharmacists (response rate 51%).Results:More than one quarter (27%) of the respondents was aware of the Guidelines. The Guidelines were made known to the respondents mostly via a book on patient counselling skills (41% of those knowing the Guidelines), continuing education (37%), and in-house training (28%). Over 60% of those who knew about the Guidelines regarded them as a good or very good instrument for learning the principles of patient counselling. The Guidelines were considered less useful as an instrument for the self-evaluation of performance in different settings.Conclusion:The results of this study indicate that even though the USP Guidelines have been promoted strongly through basic and continuing education during the TIPPA Project, more than half of the respondents were not aware of the Guidelines. The Guidelines were considered more useful in learning the principles of patient counselling than learning self-evaluation of performance.

Quality Assurance Instrument Focusing on Patient Counseling

BACKGROUND Patient counseling is a professional service provided by community pharmacists. To assess the quality of these services, specific quality assurance instruments are needed. OBJECTIVE To develop a validated, easy-to-use patient counseling quality assurance instrument for community pharmacists. The development process was part of a national project to enhance patient counseling in community pharmacies (TIPPA 2000–2003). METHODS A modified Delphi method was used with 2 expert panels: Panel 1, consisting of experienced pharmacy practitioners (n = 10), and Panel 2, consisting of academic and professional experts (n = 10). The final consensus was assessed by a Delphi questionnaire round involving both panels, the employers of Panel 1 members (n = 5), and the members of the executive board of the TIPPA project (n = 10), comprising 35 people (response rate 74%; n = 26). RESULTS The first Delphi round yielded a high consensus, with the level of agreement varying between 69% and 100%. All but one item met the predefined criteria for approval. A total of 16 indicators were identified in 3 quality dimensions: patient (4 indicators), process (6), and learning and innovations (6). Strategy and vision of the pharmacy in patient counseling formed the core of the instrument. CONCLUSIONS The modified Delphi method proved to be applicable in the development process of an instrument assessing patient counseling services. The instrument comprehensively takes into account factors related to quality assurance of counseling practices.