3 Barriers to Effective Patient Counseling in the Community Pharmacy Setting

By: Leeandrea Jones, Pharm.D. Candidate 2021

The profession of pharmacy is in the midst of significant transitions. It is possible that, over the next few years, the traditional community pharmacist will become extinct due to numerous factors.

The growth of internet pharmacies, along with advances in technology, poses possible threats to the profession. With the large use

Leeandrea Jones of technology in pharmacies, including electronic patient profiles, electronic pill counters, robotic prescription filling and more, one may question the need for pharmacists today. The answer to that question is simple. Although technological advances aid pharmacists in numerous ways and provide many benefits to the profession, it simply cannot replace the personalized relationship and trust that is built between a pharmacist and patient during a face-to-face consultation.

Throughout my didactic portion of pharmacy school, the importance of patient counseling was drilled into the heads of my classmates and I. We are trained to understand and know that this is one of the most important duties of a pharmacist. What good is it to dispense the appropriate inhaler to manage a patient’s asthma if he or she is unclear on how

to use it correctly, right? Pharmacists have the ability to directly affect patient health outcomes by providing education on medication and encouraging compliance to therapy. This process not only helps avoid medication errors but also improves health outcomes and the patient satisfaction. During my introductory pharmacy practice experiences and advanced pharmacy practice experiences community rotations, I was surprised to observe how difficult it was for pharmacists to provide quality medication counseling to patients. I had been informed that the community pharmacy setting was extremely fast paced and busy, but did not come to terms with what that truly meant until I was in the midst of what felt like organized chaos. There are numerous barriers that prevent pharmacists from providing quality patient counseling, some more difficult to overcome than others. The following three barriers pose as potential challenges, but can provide great satisfaction if overcame.

Embarrassed Patients

When it comes to managing a patient’s health, there are numerous reasons a patient may feel embarrassed. Whether it is a young woman receiving medication for a sexually transmitted disease, an elderly man receiving medication for erec

tile dysfunction or any other similar scenario, the last thing certain patients would like to do is discuss their medication and particular situation with a pharmacist.

Embarrassment can keep a patient from seeking medical treatment and proper advisement on their condition or medication. In certain situations, some patients may have questions about their therapy, but feel the question is silly or is uncomfortable interrupting a busy pharmacist or technician.

Making the first move by asking if they have any questions in regards to their medication or simply expressing your willingness to discuss the patient’s therapy with them can go a long way. In addition, having a designated area in the pharmacy where private consultations are held can possibly put the patient’s anxiety at ease. This area should provide enough privacy that allows patients to speak openly without fear of being interrupted or overheard. Pharmacists should also display empathy when providing patient counseling. It is important to reassure patients that they should not feel embarrassed and you are here to help.

Constant Multitasking

In the community pharmacy setting, it can be easy for pharmacists and staff members to feel overwhelmed. Between processing and dispensing prescriptions, checking the phone for voicemails, assisting with the front desk and drive through, managing the staff, performing immunizations and so many other tasks, there is barely enough time for the pharmacist to take a five-minute restroom break, let alone spend time with a patient to counsel on the correct use of their medication.

When the pharmacy grows overwhelmingly busy, it is important for pharmacists to remember that they are a part of a team. In many cases, the productivity in a work day is largely dependent on how smoothly the team operates. Effective delegation is crucial when working in a busy pharmacy. It reduces the workload on the pharmacist, providing the opportunity to spend more time counseling patients, while also providing your employees with more responsibility, showing that you trust them. In addition, recognizing and utilizing the skills and strengths of your employees fosters an environment where the best of everyone is given.

These changes will be extremely important when new Board of Pharmacy rules take effect that allow pharmacists to manage chronic and non-chronic diseases. When that happens, expect the role of the pharmacist to be significantly increase in patient care.

Performance Metrics

Many pharmacists working for large chain pharmacies complain about the struggles to meet corporate pharmacy metrics while performing the many task required of a pharmacist.

According to a New York Times article, large chain pharmacy companies were found to be aggressive in imposing performance metrics while simultaneously attaching bonuses to achieving them. 1 Nearly every task performed in the pharmacy is tracked, analyzed and used to evaluate employees. This includes phone calls to patients, phone hold time, how often a pharmacist makes a correction to a prescription a technician entered, the time it takes to fill a prescription, the number of vaccines administered, the number of customers signing up for 90-day supplies of medication, to name a few.

While representatives from large chain pharmacies may argue that performance metrics are in place to enhance patient care, one can argue that metrics place unnecessary pressure on pharmacy staff that can jeopardize patient care. In addition, the continuous downsizing of staff has contributed to chaotic work environments. Pharmacists should never feel forced to choose between meeting certain standards or targets over taking the time to provide quality counseling to a patient. It is imperative to remember that productivity and profit does not come before patient care. Ensuring patient safety, providing education and advocating for patients must remain a top priority that should not be jeopardized by meeting certain performance metrics.

While it is not uncommon for patients to look up information regarding their medication on the internet or read the information listed on the package label, these practices may not be enough for patients to fully understand their therapy. A patient’s knowledge of why they are taking their medications and the consequences of nonadherence is critical to achieving the best possible health outcomes. Barriers to providing quality patient counseling can pose as potential threats to a patient’s health and safety.

The lack of time available to spend with patients along with an environment that fuels the possibility of medication errors is frightening. One of the main responsibilities of a pharmacist is to ensure a patient’s safety and wellness. It is incredibly difficult for an overworked, distracted pharmacist to fulfill this responsibility in a chaotic environment that places meeting certain performance metrics above anything else. Pharmacists must collectively advocate for the well-being of themselves and their patients, without fear of being ignored or replaced by someone who is willing to work in a dangerous environment for less pay. Change will not come from being quiet or complacent. By identifying potential barriers to providing quality medication counseling to patients, strategies can be implemented to overcome them, leading to better patient health outcomes.

It is recognized that in the world of business and industry that productivity, efficiency and proficiency are critical to the profitability of services provided. These principles are expected in the production of tangible products. These general core business measures should not be a substitute for quality, safety and best practices in the provision of patient care.

References: 1. 1. Gabler, E., 2020. How Chaos At Chain Pharmacies Is Putting

Patients At Risk. [online] Nytimes.com. Available at: <https:// www.nytimes.com/2020/01/31/health/pharmacistsmedication-errors.html> [Accessed 22 September 2020].