Chapter 4. Patient-Centeredness in Pharmaceutical Care

1. Patient-centered behavior includes a number of constructs, but the most important one is that the patient comes first.

2. What the patient wants and needs is what drives the patient encounter.

3. Little can be accomplished until the practitioner understands the patient's concept of his illness and his medication experience, in the patient's words, so listen closely.

4. The therapeutic relationship is a partnership or alliance between the practitioner and the patient for the very specific purpose of optimizing the patient's medication experience.

5. The quality of the care provided will depend on the quality of the therapeutic relationship developed because the relationship will impact the information shared, the decisions made, and what you can learn from the patient.

6. The patient has both rights and responsibilities; practitioners must attend to both.

7. Adherence to a medication regimen is a test of the practitioner's ability to practice in a patient-centered manner.

8. Medication management services, when provided in a patient- centered manner, can achieve adherence rates of over 80%, consistently, because of the active participation of the patient.

9. Patient-centered adherence can be achieved when the practitioner takes into account the patient's individual needs, his rights, his responsibilities, and the practitioner's obligation to make decisions in a consistent, systematic, and comprehensive manner for each individual patient.

The concept of patient-centeredness can be a difficult idea to “get your arms around,” which makes it hard to operationalize it in practice. Because it is a concept that reflects so many general “feelings” among other things, it is important to ask, “Where do I begin to ensure I practice in a patient-centered manner”? Oliveira and Shoemaker provide a useful framework for thinking about this question.1

Fortunately, when you practice pharmaceutical care, you will always think in a specific, structured order. What you do for each patient has a clearly defined beginning, middle, and end.

This may seem a bit counterintuitive because this practice is mostly about medications; however, in order to get the medications right, you must understand that the patient-specific context in which you are going to make your decisions is most important. This translates in practice, to understanding what your patient wants and needs before you address their medical conditions and medications. This is why a physician starts a patient interview with, “What can I do for you today?” Only after the physician understands what is most important to the patient—why the patient came to see the physician—does he begin to understand the medical problem at hand. This is true in pharmaceutical care practice also. This is a service so what the patient wants is most important.

In order to understand what the patient wants and needs, it is necessary to understand how the patient thinks about his illness and his medications. What the patient thinks is ...