Written by: Lorie Spence and Carolyn Pritchard
Originally published by: Canadianhealthcarenetwork.ca
How we define and deliver patient-centred care is constantly evolving. While you can find countless articles about the sometimes-ambiguous term and what it means, ultimately it comes down to looking for ways to deliver collaborative care better suited to patients’ changing needs to continue to improve disease outcomes. According to the World Health Organization (WHO) which has evolved the term to “people-centred” care, it can be defined as “care that is focused and organized around the health needs and expectations of people and communities rather than on diseases.”(1)
Today, we find ourselves in the middle of a major shift, requiring all healthcare professionals to work together and adapt how they practice to account for the new motivated patient, and the effects of the COVID-19 pandemic. This challenge provides great opportunity for pharmacists, who continue to have constant contact with their patients, and the platform to enhance patient engagement, education and understanding.
The impact of COVID-19 on patient-centred care
Over the last 6 months, patients have had limited access to many members of their healthcare team. While restrictions have been put in place to protect Canadians from the pandemic, many individuals who have medical conditions deemed non-urgent have not received the attention they need. Dr. George Heckman explains in a CMAJ article COVID-19 Response and Chronic Disease Management, “Those with chronic cardiac or lung disease may see mild symptoms worsen to the point of requiring hospitalization. Vulnerable older adults who are discharged from home and community services may fall victim to exacerbation of conditions that had previously been stable with appropriate community supports.”(2) Many groups of patients require continuing care but are currently faced with obstacles as their regular clinics are working below capacity.(2) While pharmacists have always been the most accessible of all healthcare professionals, available by phone, evenings and weekends for support, their role has become even more pivotal amidst the pandemic as a consistent point of contact.
The motivated patient
The shift we’re experiencing towards patient-centred care can be attributed to more than just the pandemic. Even before COVID-19 hit, we started to see patients being more actively involved in the healthcare journey – from involvement in all stages of the therapeutic lifecycle, to shared decision making and customized treatment plans, to greater ability for self-management through technology, patients are no longer passive participants along for the ride.
What do patients need now?
“What do patients need now?” is a question we must continue to ask ourselves. Taking into account the motivated patient in the COVID-19 environment, how do we facilitate two-way communication to identify knowledge gaps, dispel misinformation, gain insight into personal experiences and improve patient outcomes?
One prevalent issue right now is medication adherence – an important part of managing health, especially for those with chronic medical conditions. In a recent article in the Pharmacy Times, Amy Kennedy explains, “Nonadherence to medications has been correlated to up to 50% of treatment failures, approximately 125,000 deaths, and nearly 25% of hospitalizations per year in the United States.”(3) While these statistics come from our neighbouring country, the trend is reflected in Canada. Unfortunately, COVID-19 has had a negative impact on drug adherence, as a result of many factors.
• Decrease in regular physician visits
• Revision of physician billing structures to accommodate over-the-phone appointments
• Wide-spread lay-offs, which means the loss of private drug coverage for many
• Impact on patient trust as a result of a handful of drug shortages and contamination issues
For pharmacists, this means that dispensing medication is only half the battle. Pharmacists are a trusted source of information, and have insight into the medications of their patients. During this time especially, these insights are a valuable piece of information to understand medication adherence and intervene where necessary. As explained in Exploring the concept of patient centred communication for the pharmacy practice, solely providing information or education appears ineffective to improve adherence or clinical outcomes. Rather, it’s imperative that pharmacists communicate with patients about their experiences, needs and concerns regarding health and medication.(4) Furthermore, the patient supports some pharmacists provide, such as training individuals to do their own injections, can mean the difference between continuing to adhere to treatment or the risk of delayed treatment – especially as the pandemic has given rise to new needs. Addressing these needs is patient-centred care in its truest form.
How can we deliver?
Supporting patients effectively is a necessary, but seldom an easy task. This being said, we believe there are concrete tools that can be used to embrace this shift we’re seeing in healthcare and help pharmacists collaborate with their patients. We’ve developed a number of solutions through CONNECT communications that we believe will make a difference in facilitating effective communications with patients.
- Clinical support tools – Resources for physicians and pharmacists to help facilitate information transfer between HCPs and provide prompts for patient interactions. These could include flow sheets, check lists, transition guides, etc.
- Patient-centred care tools– Communication tools designed to facilitate participatory medicine and shared-decision making between healthcare professionals and patients, such as patient-counselling tools and decision aids.
- Patient empowerment– Through knowledge, resources and skills, we can empower patients to take ownership of their disease management and participate as an active member of the team. This could be as simple as knowledge distillation through print-outs and videos, or a digital app to help them manage their condition.
- Experiential insights– Getting direct insights from patients to address challenges and barriers through patient advisory boards and focus groups. These activities would provide an opportunity to build collaborative relationships with patients and learn more about the patient experience.
Over the last while, patient-centred care has undergone a slow evolution. Now, as we experience a paradigm shift, pharmacists are a key piece to the puzzle, with the platform to disseminate not only medications, but also valuable information and resources to communicate with patients. Pharmacists stand as a vital resource to help educate and empower patients to understand their health conditions and medications.
Originally published by Canadianhealthcarenetwork.ca