History of Pharmacy/Professionalism
True/False: Advertising and commercial focus are both factors from Denzin's 1960 Marginal Pharmacy Professional Characteristics that impact how pharmacy is not viewed as "full profession" compared to doctors and lawyers, putting them at a "marginal" profession.
True, this was one of four factors discussed in this idea behind pharmacy being between a "trade" or full caring profession. The other factors include: is pharmacy recruiting truly committed professionals devoted to society, altruistic goals? Is there a body of knowledge that only can be acquired through their structure? And are pharmacists merely subservient to the physician?
Explain the nonverbal active listening acronym SOLER.
Bonus: get up and act it out :)
S- face squarely or at an angle
O- open posture
L- lean forward
E- eye contact
R- relax
What are some ways you can help improve comprehension to patients who may have low health literacy?
Share 2 :)
Teach back method, "Just to make sure I didn't leave anything out, please tell me how you are going to take this medication"
Open-ended questions
Communicating lots of info? Teach back at multiple points (chunk and check)
Use patient friendly language
What does the Kleinman model focus on?
Bonus: what is the name of the other theory that emerges from the Kleinman model and incorporates both beliefs and emotions about the patient's condition?
How a patient perceives their illness
Includes etiology (cause) factors= Why do you think this happened?
What do you call the problem?
Includes treatments (cure) factors= How do you think the illness should be treated?
How do you want us to help you?
Who should be involved in decisions?
BONUS: The Extended Common Sense Self-Regulation Model (Extended CS-SRM)
Forgetting, shift work, confusion, work restrictions, mental illness, and cost are examples _______ non-adherence.
Bonus: mental illness and cost are also examples of ________ non-adherence.
Unintentional
Bonus: intentional/belief/reflective
What is pharmacy's social object?
Ensure optimal safe and effective use of medications
List barriers that may negatively impact the sending and receiving of a message?
Hint: there is 7 from the lecture
Bonus: give examples of each :)
1. Physical - where you are!
examples: drive thru, phone, in-person
2. Physiological Barriers - include hearing and vision
**Critical to assess understanding**
example: pt speaks loudly compared to surroundings (hearing) OR seems not to be able to read bottle
3. Privacy
example: talking with a patient while other patients are waiting behind them in line versus counseling on the sildenafil at a separate counter away from registers
4. Distractions
example: a baby screaming their little head off in the pharmacy
5. Emotional
example: pt not mentally present and dealing with loss in their family
6. Relationship
example: pt will not want to engage in conversation with pharmacist who does not care
7. Power
example: pt feels belittled by pharmacist knowing they make good money (couldn't think of a better example)
What are some examples of possible indicators of health literacy?
Try to list 5 :)- rarely asks questions or asks basic questions (ie: "I take this by mouth?")
- misses appointments
- offers excuses
- does not fill out form while with provider
-brings someone along
-asks for help (or doesn't)
-asks for prescription bottles back
-refers to meds by shape and color rather than name
-opens bottle to identify med rather than using label
-difficulty explain how to take meds
-does not know purpose
-takes med wrong
Which of the following is properly matched to components to illness behavior?
a) Reaction to illness - perceived, evaluated, acted upon
b) Reaction to abnormality - hide/mask, seek fix, want to get back to "normal"
c) Symptoms - denial, action, emotion
The correct answers for the other options include:
Reaction to illness = denial, action, emotion
Symptoms = perceived, evaluated, acted upon
For this problem, you will be taken to a separate patient case PowerPoint practicing interpreting patient adherence using the scoring card we discussed in class.
What is GS's estimated probability of non-adherence?
PT GS would have a score of 11. This would be big concern for patient adherence.
From the chart we see that scores between 8-36 indicate a less than 32% probability of adherence meaning high risk for adherence issues.
What model is responsible for shifting opportunities and responsibilities in pharmaceutical care?
Hepler and Strand Model
- Determined how pharmacy can grow as a profession and become essential healthcare providers (ie, pharmacists can catch drug info/error a PCP may not see)
-Pharmacokinetic dosing, therapeutic monitoring, and drug information resource
What are two of the patient-centered components that identify and respond to patient's ideas and emotions regarding their illness?
Open-ended questions
Staying out of judgement (empathy)
Explain the PAUSE acronym when experiencing bias or stereotypes impacting your view of a patient.
P- Pay Attention to what's actually happening beneath judgements and assessments
A- acknowledge your own reactions, interpretations, and judgements
U- Understand the other reactions, interpretations that may be possible
S- Search for the most empowering, productive way to deal with the situation
E- execute your action plan
Explain the difference between primary non-adherence and secondary non-adherence?
BONUS: A drug holiday would be an example of which of these?
Secondary non-adherence = prematurely stopping a medication
A drug holiday is when multiple days of medication are missed and would be an example of secondary non-adherence.
What the dimensions of medication adherence?
Hint: there are 5!
Bonus: give one example of each!
Health care or system factors
Patient related factors
Social and economic factors
Condition related factors
Therapy related factors
Match the following ailments with the correct treatment used.
1. Constipation a. tonics
2. Upset stomach b. morphine/alcohol
3. Diarrhea c. dressings and antiseptics
4. Pain d. alcohol
5. Wounds e. laxatives
6. Malaria f. quinine (hint used 2x, AND not twice for the same option @sarah)
7. Mood g. alcohol
1. constipation = laxatives (e)
2. upset stomach = tonics (a)
3. diarrhea = quinine (f)
4. pain = morphine/alcohol (b)
5. wounds = dressings and antiseptics (c)
6. malaria = quinine (f)
7. mood = alcohol (g)
When do you use empathy? Give two main examples discussed in lecture.
-Use when there is resist to change
-Not as appropriate for responding with empathy if someone asks for a heartburn recommendation
Match the term with the correct definition.
1. Stereotype a. negative and unequal treatment of individuals based on their group membership
2. Prejudice b. generalized belief about a particular category of people; assumes shared characteristics for all individuals within a category
3. Discrimination c. negative attitude or feelings about a category of people and its individual members
1. Stereotype - generalized belief about a particular category of people; assumes shared characteristics for all individuals within a category (b)
2. Prejudice - negative attitude or feelings about a category of people and its individual members (c)
3. Discrimination - negative and unequal treatment of individuals based on their group membership (a)
List the ways adherence can be supported through medication organization.
Hint: there was 5 discussed in lecture.
1. MEMS Cap
2. MD2 Machine
3. HiDO (including video AI)
4. Pre-packaging
5. Abilify Sensor
Identify the two forms of resistance that patients may experience and how motivational interviewing addresses both. Then after naming these, complete the motivational interviewing activity to receive points. :)
1. Issue resistance - low motivation, high barriers, complex
2. Relationship resistance - patient loss of autonomy (face loss), provider tells the pt what they ought to do, absence or loss of trust
MI addresses both with synergistic effect
For activity:
-must use a "Sounds like", "You're wondering", and "Would it be alright, and tell me what you think" method or phrasing to receive full points.
Match the following pharmacy implications to their purpose.
1. Flexner Report 1910 a. drug, food, and cosmetics now tested for safety
2. APhA Code of Ethics 1969 b. defined parameters between meds, [OTC versus prescriptions (non-opioid)]
3. Kefauver-Harris Amendments 1962 c. products required to prove safety AND effectiveness before marketing
4. Durham-Humphrey Amendment 1951 d. pharmacist should hold health and safety of patients to be first consideration
5. Food Drug Cosmetic Act 1938 e. restrict the sale, trade, and importation of opiates and cocaine
6. Controlled Substances Act 1914 f. called out non-specific approaches, homeopathy, botanical therapies, etc
1. Flexner Report 1910 = called out non-specific approaches, homeopathy, botanical therapies, etc. (f)
2. APhA Code of Ethics 1969 = pharmacist should hold health and safety of patients to be first consideration (d)
3. Kefauver-Harris Amendments 1962 = products required to prove safety AND effectiveness before marketing (c)
4. Durham-Humphrey Amendment 1951 = defined parameters between meds [OTC versus prescriptions (non-opioid)] (b)
5. Food Drug Cosmetic Act 1938 = drug, food, and cosmetics now tested for safety (a)
6. Controlled Substances Act 1914 = restrict the sale, trade, and importation of opiates and cocaine (e)
Describe the characteristics of the biomedical model and the biopsychosocial model.
Bonus: act out an example activity that highlights the main components of each.
BIOMEDICAL MODEL: Focuses on diagnoses and intervention, the doctor fixes and pt plays passive role, very linear process, research goes to finding cures
example activities: one-way counseling, surgery/procedures, lab tests
BIOPYSCHOSOCIAL MODEL: Incorporates patient's illness experience, collaborative between pt and provider, focuses on pt needs, views health as a state of well-being
example activities: shared decision making, discussing alternatives to surgery, diabetes self-management support, dietary education, provide resources
What is the main idea behind the elephant and the rider?
Additionally, list the 6 moral foundations that cause the elephant to react.
True/false: These foundations only cause the elephant to react in a negative way.
Rider= rational thinking brain
Elephant= emotional instinctive brain
Although the rider is in control of the direction, the elephant is powerful and often overpowers the rider in the direction they want to go.
6 Moral Foundations
1. Care/Harm
2. Fairness/Cheating
3. Liberty/Oppression
4. Loyalty/Betrayal
5. Authority/Subversion
6. Sanctity/Degradation
False, the moral foundations can cause positive or negative reactions.
Match the following stage of change from the Transtheoretical Model with the correct descriptions below.
1. Precontemplation/Contemplation
2. Contemplation/Preparation
3. Action/Maintenance
4. Ambivalence/Resistance
a. weighing pros and cons, social liberation (fam wants this for me), self-liberation (believe I can change), self-re-evaluation
b. lower resistance, getting support, building plans and creating habits
c. helping guide them to reconsider once trust is build
d. not ready, high resistance/ambivalence where drawbacks exceed benefits, awareness can be increased
Match the following stage of change from the Transtheoretical Model with the correct descriptions below.
1. Precontemplation/Contemplation
2. Contemplation/Preparation
3. Action/Maintenance
4. Ambivalence/Resistance
a. weighing pros and cons, social liberation (fam wants this for me), self-liberation (believe I can change), self-re-evaluation
b. lower resistance, getting support, building plans and creating habits
c. helping guide them to reconsider once trust is build
d. not ready, high resistance/ambivalence where drawbacks exceed benefits, awareness can be increased
List the 5Cs Factors contributing to vaccine beliefs.
Confidence
Constraints
Complacency
Calculation
Collective responsibility