Exploring Patient Participation in Pharmacy Medication Reviews
Creators: Olufemi-Yusuf, Damilola T.
Publisher: name: University of Alberta Library
Year: 2024

<p>Comprehensive medication reviews provide an opportunity for patient-pharmacist dialogue and active patient participation in their care to identify and address their specific needs and concerns. Patient participation can contribute to positive patient experiences and high-quality care. However, little is known about the nature of patient participation during medication reviews. The purpose of this multi-paper dissertation was to (1) perform a scoping review to synthesize the literature on medication review programs in Canada and identify knowledge gaps, (2) conduct a qualitative descriptive study to explore pharmacists’ perceptions of the factors that influence patient participation in medication reviews and to describe strategies used to engage patients, and (3) conduct a multimethod study to characterize patient active participation behaviours and pharmacist communication behaviours and describe patients’ experiences with medication reviews.<br>
The first study, a scoping review, identified 41 papers on medication reviews in Canada. The majority of studies were conducted in Ontario. Quantitative research methods were predominantly employed. The main research areas identified were program uptake, health outcomes, stakeholder beliefs and attitudes toward medication reviews, processes and collaboration, and pharmacy workplace culture. There was limited research on patient-pharmacist interactions, particularly patient participation. The review also highlighted the need for research to use theoretical frameworks to enhance understanding.<br>
The second study used a qualitative descriptive methodology. Semi-structured interviews with 12 community pharmacists in Alberta were conducted and analyzed using the expanded Linguistic model of patient participation in care. Pharmacists described patient predisposing, patient internal enabling, external enabling, and pharmacist factors influencing patient participation. Pharmacists perceived it was their job, as medication experts, to engage patients in medication reviews. However, it was challenging to engage individuals who had few perceived health needs, stable medication therapy, limited experience with the pharmacist&#39;s patient care role or those who resisted pharmacists’ questions. Busyness was identified as a barrier, while patient knowledge and communication skills facilitated patient participation. To address the barriers, pharmacists used several strategies tailored to their perception of patients and workplace routines, such as adapting questions, explaining the purpose of the review, using patient laboratory results, incremental reviews, having a go-to location, scheduling strategies and respecting nonparticipants.<br>
The third study was a multimethod study involving 11 audio-recorded observations of medication reviews and five patient interviews. Analysis of medication reviews based on the Active Patient Participation Coding system showed that patients demonstrated assertive behaviours in these interactions and less commonly asked questions, expressed concerns or used humour. Pharmacists asked questions eight times more frequently than patients. Pharmacists used supportive talk to encourage, reassure, and empathize with patients, three times more frequently than partnership building. Humour and social talk were highlighted as important ways to enhance patient participation in the interaction. Patients reported positive experiences and emphasized pharmacists’ caring behaviours and trusting relationships as supporting their participation.</p>

<p>The overall findings of this dissertation provide insight into the barriers to active patient participation and a range of pharmacist strategies to support patient participation. The findings also add to the limited body of evidence on active patient participation and pharmacist behaviours expressed during comprehensive medication reviews, enhancing our understanding of this crucial element of patient-centered care. The research results could inform developing, implementing, and evaluating strategies that foster patient participation in medication reviews.</p>