Communication of the Pharmacist with the Patient in the Context of the COVID-19 Pandemic

MOROȘAN Elena1, MITITELU Magdalena1*, NICOLESCU Florica2, NEACȘU Sorinel Marius1, UDEANU Denisa Ioana1, DUMITRESCU Denisa Elena3, ERIMIA Cristina-Luiza4, NICOLESCU Teodor Octavian5

1Clinical Laboratory and Food Hygiene Department, Faculty of Pharmacy, ”Carol Davila” University of Medicine and Pharmacy, 6, Traian Vuia Street, 020956, Bucharest (ROMANIA)

2Toxicology Department, Faculty of Pharmacy, ”Carol Davila” University of Medicine and Pharmacy, 6, Traian Vuia Street, 020956, Bucharest (ROMANIA)

3Organic Chemistry Department, Faculty of Pharmacy, Ovidius University, Constanța (ROMANIA)

4Ovidius University of Constanta, Faculty of Pharmacy, Campus Corp C, Constanta (ROMANIA)

5Organic Chemistry Department, Faculty of Pharmacy, ”Carol Davila” University of Medicine and Pharmacy, 6, Traian Vuia Street, 020956, Bucharest (ROMANIA)

 *corresponding author: magdamititelu@yahoo.com 

Abstract

     The pharmacist is the most frequented health care professional and therefore he has a significant role and has the responsibility of educating the patient so as to reduce medication errors. At European level, one of the basic functions of the pharmacist, as an expert in the field of medicine, is to help prevent the avoidable risks of medication errors. Pharmacists need to help educate patients and make them aware of the risk of medication errors.

      In the special context of the COVID-19 pandemic, the pharmacist’s position overcame changes by reducing direct contact with the patient which led to impaired privacy and a special effort by the pharmacist not to alter the quality of communication with the patient.

Keywords: communication with the patient, COVID-19 pandemic, pharmacist, community pharmacy

Introduction

     In the community pharmacy (the open circuit pharmacy) the essential role of the practicing pharmacist does not consist only in the correct preparation and distribution of medicines. This role is accompanied by observations, indications and advice through which the pharmacist contributes to a better understanding of the treatment by the patient and, finally, to the enrichment of the therapeutic effect, leading to recovery and the patient’s desire to return to pharmacy.

      The majority of patients at the community pharmacy are individuals. Whether they go to pharmacies for their own health needs or belong to people with health needs, each patient has their own personality. The pharmacy-patient relationship ultimately involves an interpersonal relationship between two or more people, the pharmacist or pharmacy assistant – as an employee, a specialist in the field – on the one hand and the patient – as an individual – on the other [1,2].

The key point in the relationship between the pharmacy and the patient is the correct identification and satisfaction of his needs.

       Patients are unaware of the potential errors and often do not take an active role in understanding what is being communicated to them with the released drug. Such errors occur when the communication is unclear as to the name of the medicine, its appearance / labeling, why it should be taken, how and when, what is the most appropriate time for its administration, what are the side effects that occur, which are the interactions and contraindications in relation to his other ailments or other drugs administered for other disease conditions, or the patient does not understand whether the new drugs replace or strengthen the previous medication. Such matters must be reported by the pharmacist [3,4].

Patient expectations

    Each of the patients expects to find a KIND and TRUSTED team in the pharmacies.

THE PATIENT WANTS

TO FIND
KIND AND RELIABLE TEAM VISIBLE AND AVAILABLE PHARMACY THE PRODUCT YOU NEED A CORRECT PRICE

The needs of the individual crystallize depending on the field of activity or the group to which he belongs. If this is the case, the question arises where we frame the need of our consumer to buy pharma or non-pharma products.

       Is this need among the physiological, social or personal needs?

       We will know the answer only if we find out the hierarchy of the needs of the respective consumer, and not of the individual in general, as an abstract person [5,6].

What does the patient want? 

  • Physiological needs: food, water, oxygen, shelter.

Security: the desire not to worry, to be in a comfortable environment, to be able to count on others.

  • Belonging: the desire for social interaction, friendship, kindness from others.
  • Recognition: the desire to be seen as important by those around you.
  • Self- accomplishment: the desire to develop continuously.

The factors that limit the manifestation and satisfaction of needs are [7,8]:

  1. Lack of money – up to a certain point, the consumer can overcome such difficulties, either through hard work or by accepting a series of budgetary restrictions.
  2. General opinion – each group is an attitude towards a phenomenon, product, event. Unlike the financial factor, the dominant opinion in a group is difficult to overcome, to change, whatever the will of the individual.
  3. Limited time – time is relatively inflexible as a limiting element of meeting needs. The individual does not have more than 6-7 hours a day in which to be interested in anything other than work, meals and sleep, of which a small part is used for shopping. The only days when the time dedicated to them increases significantly are those of the weekend.
  4. Lack of space – is an element even more rigid than the time factor. For example, no matter how hard we try to decorate the house by doing the necessary shopping, it will be very difficult to equip it with what we would have wanted if we did not have a place to place those objects.
  5. Fatigue – to the lack of time can be added the lack of mood, especially after working hours, given that shopping turns out to be a tiring activity. Under these conditions, the customer becomes more comfortable, looking for faster and simpler solutions to meet his needs.
  6. Poor reputation of a product or service – this factor can lead directly to the refusal of the consumer public to purchase it. To counteract such a situation, it is recommended to provide adequate information to consumers.

         The buyer is subject to various influences, does not always act in a rational manner, and the decision-making process and purchasing behaviour vary depending on the person, the product and the purchasing situation.

OUR BARRIERS: Why can’t we understand others?

The most common causes [7,8]:

  • Lack of communication
  • Lack of listening
  • The fear
  • Self-centeredness

Related:

THE ATTITUDE ANSWERS
  • Listen with interest
  • Clarifies the objection
  • Does not contradict
  • Treat the objection with respect
  • Don’t forget what your goal is
  • Clear and concise
  • Weakens the objection with arguments
  • Answer directly using the objection and turn it into a question
  • Give him an alternative if you don’t have a clear answer.

     For example, when a pharmacist is faced with a prescription for a patient who has never received medication, the three most important elements of the pharmacist’s consultation with the patient are: instructions for use, name and purpose of the medication, and side effects. If it is the case of a repeated prescription, the patient being accustomed to the medication, the three most important elements become: instructions for use, monitoring and information on contraindications [6,7,8].

      We must keep in mind that the pharmacy also includes sick people with a much lower percentage of information retention. This causes the pharmacist to pay full attention to the patient’s training, asking him what he understood, to ensure that the treatment will be followed exactly. Often, patients do not understand what is happening to them. Aspects of the disease may remain unclear to them, even after repeated discussions with their doctors. Their fear and anxiety can be alleviated by simpler explanations, in words that make sense to them, by reassurance and encouragement from the doctor, pharmacist, and others involved in caring for the patient [4,5].

     Patients who are hostile and uncooperative need patience and understanding. Fear of helplessness and addiction often leads to this type of behaviour. Pharmacists need to help patients self-motivate, they don’t need to argue, they need to explain how the medication works and how it helps to cure or relieve symptoms, rather than discussing the importance of taking the prescribed medication. Even if it is easy to get angry with hostile and uncooperative patients, pharmacists need to understand the reasons for this disease-altered behaviour in order to achieve effective communication [7,8].

     Although the profession of pharmacist is approached differently in the world, depending on the specifics and tradition of each country, the fundamental principles underlying “pharmaceutical care” should be common. “Pharmaceutical care” states that the main role of the pharmacist is to care for the patient. He puts his knowledge, qualities and professionalism at the service of preventing and solving the patient’s drug-related problems. This involves more than a thorough knowledge of the drug and the disease, because “pharmaceutical care” means ensuring that every aspect with an impact on medication is performed in optimal conditions [9-11]. The pharmacist must take responsibility for the patient and improve his quality of life. Pharmacist intervention activities include choosing the most appropriate methods with the patient, choosing the most appropriate methods with other professionals, promoting a healthy lifestyle, ensuring rational individual treatment (social or legislative aspects), establishing the therapeutic plan, identifying therapeutic effects expected, patient education and counseling and of course monitoring therapy [12-18]. Finally, the evaluation of therapeutic results involves careful monitoring of changes in clinical condition or symptoms, improved quality of life related to health in close connection with pharmaco-economic factors and ultimately comparing the results with those expected in the initial plan and adapting the therapeutic plan to new conditions [19-23]. The structural elements of pharmaceutical care consist of documentation activities that include medication history, disease history, living conditions (social, family), results of laboratory tests and individualized pharmaceutical care plan, communication activities with the patient, with other professionals in the field. and other health care providers (social workers, psychologists, political, executive, legislative power factors) and monitoring activities such as compliance with medication and lifestyle, compliance with the pharmaceutical care plan, evaluation of clinical outcomes and scheduling of patient meetings. The pharmacist is the intermediate link between the prescriber and the consumer. His professional advice is essential for the patient, and the safety of the patient is a priority [24-30].

     With the onset of the COVID-19 pandemic, a number of significant changes occurred in the organization of office space. First of all, the direct contact with the patient was reduced by mounting screens to protect the pharmaceutical staff. Second, patients’ access to the pharmacy was limited while maintaining a minimum safety distance between patients.

      Third, governments have imposed restrictive measures to protect the population, which have limited the movement of citizens and especially the elderly who are at the highest risk for new coronavirus infection. All these affected the quality of the pharmaceutical act, first of all by affecting the intimacy of the communication with the patient, the appearance of screens and the imposition of social distances as well as the limitation of the time needed to serve each patient led to a depersonalization of the pharmaceutical service, as well as the appearance of a restraint on the part of the patients regarding the degree of openness in communication with the pharmacist. In addition, the pharmaceutical staff had to make additional efforts to eradicate the barriers encountered in the act of communication and service to the patient, barriers caused by the context of the COVID-19 pandemic.

      With additional effort and dedication, most specialists in the pharmaceutical field managed to cope with the new situations and to ensure a service of patients in optimal conditions at the level of community and hospital pharmacies in Romania.

Conclusions

       The pharmacist is not just a salesperson, he must identify the patient’s needs very well, have an arsenal of high-performance communication tools and apply them every time a patient is in front of him who cannot define his needs very well, and then to explain its meaning, administration, side effects, etc. Communication is included among the fundamental needs of a person in general, a person who is suffering and elderly all the more so. Every person is a human entity whose needs and resources are individual and specific. Thus, human needs are presented as multiple and complex, the purpose of satisfaction being to obtain a “state of well-being”, comfort, to increase the quality of life.

       In the context caused by the COVID-19 pandemic, the need for communication of patients and especially the elderly has increased due to the anxiety caused by the infection with the new coronavirus and the high death rate, especially in the elderly and those with diseases serious.

       The special measures imposed to protect the population and the pharmaceutical staff have made the pharmaceutical service more difficult, but the specialists in the Romanian pharmaceutical field have managed to face the new challenges and to ensure optimal and continuous pharmaceutical services for all patients.

REFERENCES

  1. Asnani, M.R. (2009). Patient-physician communication. WestIndian Med J, 58(4):357-61
  2. Clark, P.A. (2003). Medical practices’ sensitivity to patients’ needs: Opportunities and practices for improvement. Journal of Ambulatory Care Management, 26(2), 110-123
  3. Wanzer, M.B., Booth-Butterfield, M., Gruber K. (2004). Perceptions of health care providers’ communication: Relationships between patient-centered communication and satisfaction. Health Care Communication, 16(3), 363-384
  4. Duffy, F.D., Gordon, G.H., Whelan, G., Cole-Kelly, K., Frankel, R. (2004). Assessing competence in communication and interpersonal skills: The Kalamazoo II report. Academic Medicine, 79, 495-507
  5. Heisler, M., Bouknight, R.R., Hayward, R.A., Smith, D.M., Kerr, E.A. (2002). The relative importance of physician communication, participatory decision-making, and patient understanding in diabetes selfmanagement. Journal of General Internal Medicine, 17, 243-252
  6. Renzi, C., Abeni, D., Picardi, A., Agostini, E., Melchi, C.F., Pasquini, P., Prudu, P., Braga, M. (2001). Factors associated with patient satisfaction with care among dermatological outpatients. British Journal of Dermatology, 145, 617-623
  7. Makaryus, A.N., Friedman, E.A. (2005). Patients’ understanding of their treatment plans and diagnosis at discharge. Mayo Clinic Proceedings, 80(8), 991-994
  8. Thiedke, C.C. (2007). What do we really know about patient satisfaction? Family Practice Management, 33-36
  9. Ioniţă, A.C., Mititelu, M., Moroşan, E. (2014). Analysis of heavy metals and organic pollutants from some Danube river fishes. Farmacia 62(2), pp. 299-305
  10. Mititelu, M., Ghica, M., Ioniţă, A. C., Moroşan, E. (2019). The influence of heavy metals contamination in soil on the composition of some wild edible mushrooms. Farmacia 67(3), pp. 398-404
  11. Mititelu, M., Moroşan, E., Neacșu, S. M., Ioniţă, E. I. (2018). Research regarding the pollution degree from romanian Black Sea coast. Farmacia 66(6), pp. 1059-1063
  12. Mititelu, M., Moroşan, E., Iosif, M., Ioniţă, E. I. (2018). Analisys of quality of different types of honey from various sources. Proceedings of The Romanian National Congress of Pharmacy – 17th Edition, “21st Century Pharmacy – Between Intelligent Specialization and Social Responsibility”, Filodiritto Editore – Proceedings, pp. 84-87
  13. Mititelu, M., Nicolescu, T. O., Moroșan, E., Pop, A. L., Nicolescu, F. (2020). Study of Hypolipemiant Activity of Some Mussel Extracts. Proceedings of 6 th International Conference on Interdisciplinary Management of Diabetes Mellitus and its Complications INTERDIAB (Bucharest, Romania, 5-7 March 2020), Filodiritto Editore – Proceedings, pp.338-343, ISBN 978-88-85813-79-3
  14. Ioniță, A. C., Mititelu, M., Nicolescu, T. O., Nicolescu, F., Moroșan, E., Ozon, E. A., Ioniță, E. I., (2020). Research on the Hypolipidemic Action of Almond Oil and Almond Seeds. Proceedings of 6 th International Conference on Interdisciplinary Management of Diabetes Mellitus and its Complications INTERDIAB (Bucharest, Romania, 5-7 March 2020), Filodiritto Editore – Proceedings, pp. 326-331 
  15. Ioniță, A. C., Nicolescu, T. O., Ioniţă, E. I., Nicolescu, F., Mititelu, M. (2020). Chemical-Toxicological Research on the Evaluation of Serum Malondialdehyde Levels in Patients with Diabetic Arteriopathy. Proceedings of 6 th International Conference on Interdisciplinary Management of Diabetes Mellitus and its Complications INTERDIAB (Bucharest, Romania, 5-7 March 2020), Filodiritto Editore – Proceedings, pp. 320-325
  16. Mititelu, M., Nicolescu, T. O., Udeanu, D. I., Nicolescu, F. (2020). Research on the Influence of Some Sweeteners on Body Weight and Blood Glucose in Laboratory Mice. Proceedings of 6 th International Conference on Interdisciplinary Management of Diabetes Mellitus and its Complications INTERDIAB (Bucharest, Romania, 5-7 March 2020), Filodiritto Editore – Proceedings, pp. 332-337
  17. Ghica, M., Băncescu, I., Udeanu, D. I., Tăerel, A., Arsene, A. L., Anuța, V., Velescu, B. Șt., Gerghiceanu, F., Mititelu, M., Ioniță, A. C. (2020). Computational Approach for Small Data in Animal Models with Induced Metabolic Disorders. Proceedings of 6 th International Conference on Interdisciplinary Management of Diabetes Mellitus and its Complications INTERDIAB (Bucharest, Romania, 5-7 March 2020), Filodiritto Editore – Proceedings, pp. 98-106
  18. Drăgoi, C. M., Moroșan, E., Dumitrescu, I.B., Nicolae, A. C., Arsene, A. L., Drăgănescu, D., Lupuliasa, D., Ioniță, A. C., Pantea A., Stoian, C. Nicolae, Rizzo, M., Mititelu, M. (2019). Insights into chrononutrition: the innermost interplay amongst nutrition, metabolism and the circadian clock, in the context of epigenetic reprogramming. Farmacia 67(4), pp. 557-571
  19. Ioniță, A. C., Ghica, M., Moroșan, E., Nicolescu, F., Mititelu, M. (2019). In vitro effects of some synthesized aminoacetanilides N’- substituted on human leukocytes separated from peripheral blood. Farmacia 67(4), pp. 684-690
  20. Manolescu, B. N., Oprea, E., Mititelu, M., Ruta, L., Fărcășanu, I. C. (2019). Dietary anthocyanins and stroke: a rewiew of pharmacokinetics and pharmacodynamic studies. Nutrients 11(7), pp. 1479
  21. Mititelu, M., Ioniţă, A. C., Moroşan, E. (2014). Research regarding integral processing of mussels from Black Sea. Farmacia 62(3), pp. 625-632
  22. Carje, A.G., Balint, A.; Ion, V.; Pop, A.L.; Muntean, D.-L.; Sabau, R.; Imre, S., (2019). HPLC-UV Method Approach For The Analysis And Impurity Profiling Of Captopril, Studia Universitatis Babes-Bolyai Chemia Volume 64, Issue 2, pp. 231-242
  23. Ciobanu, A. M., Pop, A. L., Crişan, S., Pali, M., Burcea-Dragomiroiu, Popa, D. E. & Bârcă, M. (2017). HPLC studies for assessing the stability of carvedilol tablets. Farmacia, 65, 523-531
  24. Bârcă, M., Manda, G., Ciobanu, A. M., Bălălău, C. Lupuleasa, D., Burcea Dragomiroiu, G. T. A. & Baconi, D. L. (2017). Immunomodulatory effects of methadone following methotrexate therapy in a rat model of arthritis. Farmacia, 65(3), 423-428
  25. Onisei, T., Pop, A.L., Crisan, S., Pop, C., Cauni, D., Ciobanu, A.M. (2019). Novel Foods. European and Romanian Legislation in Force. Working Algorithm,  Proceedings of The Romanian National Congress of Pharmacy – 17th Edition, “21st Century Pharmacy – Between Intelligent Specialization and Social Responsibility”, Filodiritto Editore – Proceedings, pp. 56-161
  26. Mihai, S., Dumitrescu, D. E., Răducanu, M. A., Stoicescu, I., Badea, V. (2019).  Phytochemical Profile and Total Antioxidant Capacity of Sempervivum Ruthenicum Koch Hydroethanolic Extract. Revista de Chimie, 70 (1), pp. 23-26
  27. Institute of Medicine. (2003). Health professions education: A bridge to quality. Washington, D.C.
  28. Stewart, M., Brown J., Donner, A., et al. (2000). The impact of patient-centered care on outcomes. J Fam Pract.;49:805-807
  29. Drăgănescu, D., Lupuliasa, D., Alexandru, G.T., Dragomiroiu, B., Roșca, A.C., Hîncu, L., Cioacă, D. (2019). 3D printing pharmaceutical formulation of drugs in personalized therapy, Farmacia, 67(1), pp.1-9
  30. Lupuleasa, D., Drăgănescu, D., Hîncu, L., Tudosă, C. P., Cioacă, D. (2018). Biocompatible polymers for 3D printing, Farmacia, 66(5), pp.737-746