The therapeutic alliance in pharmacy practice (bastawrous, 2014)


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Poster detailing the use of an alliance measure in routine pharmacy practice showing increased compliance with medication as prescribed.

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The therapeutic alliance in pharmacy practice (bastawrous, 2014)

  1. 1. Incorporating the Therapeutic Alliance Technique into Your Community Pharmacy Practice Tara Bastawrous, PharmD Candidate 2015, Melissa Somma McGivney, PharmD, Kim Coley, PharmD, Jan Pringle, PhD University of Pittsburgh School of Pharmacy, Pittsburgh, PA INTRODUCTION THE PROBLEM: NON-ADHERENCE 1.Describe the problem of non-adherence to medications and the importance of TA motivational interviewing. 2.Describe how to incorporate the TA technique during a “first fill” interview in a community pharmacy setting. 3.Utilize a “Therapeutic Alliance Survey” to assess the collaborative bond between the patient and the pharmacist after implementation of the TA technique. •The World Health Organization estimates 157 million Americans in 2020 will be affected by at least one chronic disease state. 1 Chronic diseases are the leading causes of morbidity and mortality in the U.S., accounting for about 70% of death.2 •According to the CDC, about 20-30% of prescriptions are never filled and about 50% of medications are not continued as prescribed.1 •Incorporating the Therapeutic Alliance (TA) technique into your community pharmacy practice has the potential to improve adherence to medications and improve patient satisfaction. • Adherence: the extent to which a person’s behavior-taking medications, following a diet, or making healthy lifestyle changes-corresponds with agreed-upon recommendations from a health care provider1 • Medication Adherence: the patients conformance with the providers recommendation with respect to timing, dosage, and frequency of medication-taking during the prescribed length of time1 • According to the CDC1 • 51% of Americans treated for HTN are adherent long term • 25-50% of patients on statins discontinue treatment within one year of starting therapy • Leads to $2000 per patient in physician visit annually OBJECTIVES • Medication therapy management is becoming increasingly important in improving patient outcomes. However, the patient-practitioner relationship may be even more important. • As the most accessible health care providers, community pharmacists serve as vital patient advocates in impacting health behaviors. Meyer, R. Non-adherence tied to high co-pays 5 THERAPEUTIC ALLIANCE • TA was first described in the setting of psychotherapy, but has spread throughout the healthcare community as a basis to establishing an important relationship between the patient and their health care providers.3 • The TA technique, establishing trust and care with the patient, was used to enhance the patient experience during an original fill of maintenance medications. Brief surveys, based upon Scott Miller’s Session Rating Scale (SRS), were administered after the interaction, assessing the patients “collaborative bond” with his/her pharmacist. 3,4,5 • Pringle and colleagues found3: • “Healthcare provider and his or her patients are equals, with both parties making decisions and acting together toward common goals.” • “Pharmaceutical care requires a much more intimate and intensive relationship between the pharmacist and patient than simple pharmaceutical dispensing.” • “Pharmacist competence, trustworthiness, and caring are core of the therapeutic alliance between a pharmacist and his/her patients.”
  2. 2. I would like to thank Dr Smith, Dr. Bacci, members and coordinators of the Community, Leadership, & Innovations in Practice group, Dr. Scott Miller who developed the SRS Scale, and Dr. Pringle for her work on Therapeutic Alliance between the pharmacy and patients. TA PROCESS This study was determined exempt by the University of Pittsburgh Institutional Review Board Patients are encouraged to enroll in pharmacy adherence programs such as automatic refill, refill synchronization, text messaging alerts, and smart phone medication adherence apps to help manage their medications Patients are then asked to answer the “therapeutic alliance” survey to assessing their “collaborative bond” with the pharmacist Patients are given a disease specific brochure and are encouraged to call their pharmacist with any questions or concerns, establishing an important relationship The pharmacist or intern utilize “therapeutic alliance” interviewing, counseling patients on potential root causes of non-adherence and the importance of refilling their medications The patient is asked to spend a few minutes discussing their new medication with their pharmacist Patient presents to the pharmacy to pick up a new maintenance medication for the first time PRELIMINARY RESULTS CONCLUSIONS • Brief communications incorporating TA assessment is a small change that can be incorporated into any pharmacy workflow, but has a great impact on patient medication adherence. • Enhancing the therapeutic relationship between pharmacists and their patients can significantly improve patients’ health behaviors including medication adherence as well as the overall effectiveness of MTM encounters. • Repetitive administration of therapeutic alliance surveys encourages pharmacists to interview patients and “actively listen” to their concerns, providing a mechanism to receive feedback from patients. • Use of a personalized approach to care positively impacts patients health behaviors. This approach establishes trust between the patient and his/her pharmacy team, empowering them to manage their medications and disease states. 1.Chowdhury F, Patel D, George M, et al. Strategies to improve medication adherence. Center for Disease Control and Prevention. 2013 2.Albrecht S. The Pharmacist’s Role in Medication Adherence. U.S. Pharmacist. 2011 3.Pringle J, Melczak, Alridge A, et al. Medication adherence and its relationship to therapeutic alliance: results from an innovate pilot study with a community pharmacy MTM practice. INNOVATIONS in pharmacy. 2011 4.S Miller. Personal communication with M. Melczak. November 2008. 5.Duncan B, Miller S, et al. The Session Rate Scale: Prelimary Pschometric Properties of a “Working” Alliance Measure. Jounral of Brief Therapy. 2003. (5) 6.Meyer, R. Non-adherence tied to high copays. 2014 • We surveyed 20 patients after utilizing the TA technique during a first fill process and 18 of 20 (90%) scored a 10/10 on the TA Session Rating Scale4.5. • The TA survey can be used to assess patient feedback with the interaction and serve as a catalyst to determine how to improve future encounters. ACKNOWLEDGEMENTS Incorporating the Therapeutic Alliance Technique into Your Community Pharmacy Practice Tara Bastawrous, PharmD Candidate 2015, Melissa Somma McGivney, PharmD, Kim Coley, PharmD, Jan Pringle, PhD University of Pittsburgh School of Pharmacy, Pittsburgh, PA REFERENCES