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Advancing Pharmacy Health Literacy Practices Through Quality Improvement: Curricular Modules for Faculty

Activity Guides (continued)

Improving Communication in Pharmacy

Activity 8: Using and Teaching the Teach-Back Method

Topic: Improving Communication in Pharmacy

Use in:

  • Didactic (in class).
  • Experiential education (APPE).
  • Project (PharmD or residency).

Time Commitment Estimate: 25 minutes (in-class); 1-4 hours (experiential education); minimum of 20 hours (project)

Learning Objectives:

  • Describe the teach-back method.
  • Use the teach-back techniques in the pharmacy setting.
  • If applicable, teach the teach-back method to pharmacy staff.

Activity Description:

In-class: Review what you learned in class about teach-back (use resources below if needed). Break into groups of three. Each person will take turns being the pharmacist, the patient, and an observer. Spend 5 minutes looking up counseling information for three different common medications provided by your professor (e.g., hydrochlorothiazide 25mg, simvastatin 40mg, hydrocodone/acetaminophen 5/500mg). Then, role play with the pharmacist counseling, the patient receiving the medication for the first time, and the third person serving as an observer. After each teach-back role play, first the pharmacist should reflect on what they did well and would have changed, then the observer should provide feedback on what the pharmacist did well and what she/he could have done better; finally, the patient should add their perspective and anything that wasn't addressed by the other two.

APPE: Use teach-back with patients on your rotation site as part of counseling on new prescriptions or your Medication Therapy Management (MTM) services. Have your preceptor observe you and provide you feedback on what you did well and what could be improved.

APPE: Using existing teach-back resources, develop a training program for pharmacy staff and/or medical students/residents at your IPPE/APPE or residency site. Consider including a didactic overview (e.g., presentation and/or articles to read) on teach-back and also consider how best to train the staff and allow them to practice (e.g., demonstrate it yourself, role play, etc.). Then consider how best to roll out use of teach-back by pharmacy staff with patients. You should work with your preceptor and/or pharmacy management to best incorporate teach-back into the workflow and ensure there is buy-in for teach-back to be implemented in the pharmacy.

Project: If this is for a project or your time at the site allows for it, you should develop a plan to assess the effect of your training; you could conduct a pre/post assessment (i.e., develop a plan to assess how much pharmacists used teach-back before and after your training, or how confident or knowledgeable staff were about teach-back before and after your training). Write-up your project with an introduction, including a description of the problem with communication in health care settings and pharmacy, the methods you used to train the staff and evaluate the effect of your training, the results section describing the effect, and finally, discussion of what you learned, reflections on the process (e.g., challenges) and recommendations for further improving teach-back in the pharmacy. The student should provide either a written report or presentation to the pharmacy preceptor, manager, and/or staff on the results.

Faculty Note: Consult with your institution's Institutional Review Board (IRB) to determine whether or not you need approval for this activity.

Evaluation Criteria:

In-class: Students will actively participate, each playing in each of the three roles.

APPE: The student should effectively use teach-back to educate patients on new medications and ensure the patient understands.

Project: Student or resident developed a high-quality training program with both didactic and practice content. If required, the student developed an effective approach for assessing the effect of her/his training on teach-back in the pharmacy. The student/resident's report is comprehensive (i.e., introduction, methods, results and discussion including reflections), and the student provided the results to the pharmacy staff, preceptor and/or management either in a report or as a presentation.

Relevant PowerPoint® Slides:

Resources:

Activity 9: Identify Commonly Used Terms in Pharmacy

Topic: Improving Communication in Pharmacy

Use in:

  • Didactic (in class or assignment).
  • Experiential education (IPPE or APPE).

Time Commitment Estimate: 15-30 minutes (in-class); 1 hour (assignment); 3-6 hours (IPPE/APPE)

Learning Objectives:

  • List and describe the expectations and demands placed on patients taking medications.
  • Describe commonly used terms and jargon in pharmacy and medication counseling.
  • Recommend replacement words or preferred words and ways to explain concepts to patients.
  • Summarize patients' input on commonly used terms and jargon.

Activity Description:

In-class: Break into groups of three to five. Compile a list of at least 15 words or "terms of art" often used in a pharmacy in communicating with patients, including words related to actual medication administration (e.g., empty stomach) as well as disease state (e.g., hypertension), insurance (e.g., prior authorization), or administrative aspects (e.g., refill). For each word, try to find a replacement word or phrase that may be easier to understand or a brief phrase that helps better explain and clarify what is meant. Write up words and proposed replacement words and/or phrases. Share paired words with the rest of the class or turn in (faculty discretion).

Assignment: Work with one or two other students to complete the activities listed for the in-class, but then turn in the list.

IPPE/APPE: Complete the activities described above, then share the list of words and share with 10 family members, friends, or patients and see which words the they think are an improvement. Also, ask what word they might suggest as a more understandable alternative. Write-up results in a two-three page report.

Evaluation Criteria: Students should come-up with at least 15 common terms and reasonable replacement words or phrases. The IPPE/APPE students should have obtained feedback from at least 10 different non-health care professionals on the words and provide a well-written summary of what the patients said about the words.

Relevant PowerPoint® Slides:

Resources:

Activity 10: Communication Training for Pharmacy Staff

Topic: Improving Communication in Pharmacy

Use in:

  • Experiential education (APPE).
  • Project (PharmD or Residency).

Time Commitment Estimate: 5 hours (experiential education); minimum of 15 hours (project)

Learning Objectives:

  • List a minimum of four barriers to effective communication in a pharmacy setting.
  • Define three reasons to train staff in communication skills.
  • Apply lessons regarding pharmacist-patient communication and health literacy in previous courses (or through review of literature) to staff training.

Activity Description: Adapt and teach AHRQ's Strategies to Improve Communication Between Pharmacy Staff and Patients to staff members in your pharmacy. Use the slides available online at http://www.ahrq.gov/qual/pharmlit/pharmtrain.htm. You may need to think creatively about how to adapt the training program to your pharmacy, including considerations of space, time, etc. For example:

  • If all staff cannot be brought together for one meeting, can the training be completed in small groups?
  • If a full training is not feasible, how else could key information be conveyed to pharmacy staff or other health professional staff? For example, can the training content be adapted to weekly postings or announcements with key points from the training over the course of several weeks, mini trainings during staff meetings.
  • Is there a specific section of the training that the staff could benefit from?
  • Project: Evaluate the effect of your presentation on pharmacy staff attitudes, knowledge and practices related to health literacy and communication with patients by surveying them before and after the training is completed to assess changes. Questions for this assessment may be taken from the AHRQ Is Our Pharmacy Meeting Patients' Needs? A Pharmacy Health Literacy Assessment Tool User's Guide, or from other sources. Sample questions include: "I am confident I can effectively educate all patients about medicines and diseases when the patient has limited literacy skills" or "I am confident I can effectively educate all patients about medicines and diseases when the patient has many medications." Write-up your project with an introduction, including describing the state of the problem with communication in health care settings and pharmacy, the methods you used to train the staff and evaluate the effect of your training, the results section describing the effect, and finally discussion of what you learned, reflections on the process (e.g., challenges) and recommendations for further improving teach-back in the pharmacy. The student should provide either a written report or a presentation to the pharmacy preceptor, management, and/or staff on the results.

Faculty Note: Consult with your institution's Institutional Review Board (IRB) to determine whether or not you need approval for this activity

Evaluation Criteria: The student or resident effectively adapted the communication strategies training to the pharmacy. If the student or resident did this activity as a PharmD or Residency project, they should have developed an effective approach for assessing the effect of her/his training on communication strategies in the pharmacy. The student/resident's report should be comprehensive (i.e., introduction, methods, results and discussion including reflections), and the student provided the results to the pharmacy staff, preceptor and/or management either in a report or as a presentation.

Relevant PowerPoint® Slides:

Resources:

  • Kripalani S, Jacobson K. Strategies to Improve Communication Between Pharmacy Staff and Patients: A Training Program for Pharmacy Staff. (Prepared under contract No. 290-00-0011 TO7.) AHRQ Publication No. 07(08)-0051-1-EF. Rockville, MD: Agency for Healthcare Research and Quality. October 2007.
  • Jacobson K, Gazmararian J, Kripalani S, McMorris KJ, Blake SC, Brach C. Is Our Pharmacy Meeting Patients' Needs? A Pharmacy Health Literacy Assessment Tool User's Guide. (Prepared under contract No. 290-00-0011 TO7.) AHRQ Publication No. 07-0051. Rockville, MD: Agency for Healthcare Research and Quality. October 2007.
  • Gazmararian J, Jacobson KL, Pan Y, Schmotzer B, Kripalani S. Effect of a pharmacy-based health literacy intervention and patient characteristics on medication refill adherence in an urban health system. Annals of Pharmacotherapy 2010 Feb;44(2):395.
  • Devraj R, Gupchup GV. Identifying Aspects of Pharmacists' Attitudes and Barriers toward Health Literacy: A Factor Analytic Study. Annals of Pharmacotherapy 2011;45:771-779.DOI 10.1345/aph.1P686.

Activity 11: Using a Pill Card or Medication List with Patients

Topic: Improving Communication in Pharmacy

Use in:

  • Didactic (assignment).
  • Experiential education (IPPE or APPE).
  • Project (PharmD or residency project).

Time Commitment Estimate: 1 hour (didactic); 3-4 hours (experiential education); minimum of 8 hours (project)

Learning Objectives:

  • Construct a pill card or medication list for a patient.
  • Explain how a pill card can assist patients with low health literacy skills and/or with multiple medications.
  • Critically assess the benefits and any drawbacks to pill cards (or a specific pill card).
  • Demonstrate how to teach a patient to effectively use a pill card/medication list within the health care system.

Activity Description:

For assignment: Given the hypothetical patient below, create a pill card or a medication list that this patient could use to help remember how and when to take her medications.

Indication Medication Dose Sig
Hypertension hydrocholorothiazide and triamterene 25mg/37.5mg 1 po qam
Hypertension lisinopril 5mg 1 po qd
Diabetes mellitus Glucotrol XL 5mg 1 po qam
Diabetes mellitus metformin 500mg 1 po bid
Hypercholesterolemia simvastatin 40mg 1 po qpm
Osteoporosis prevention calcium carbonate with vitamin D 500mg 1 po bid
General health multivitamin with minerals - 1 po qd

IPPE/ APPE: Create a pill card for a Medication Therapy Management (MTM) patient or other patient of the pharmacy, and educate the patient on his/her regimen, how to use the pill card, and what to do if his/her regimen changes.

Project: Apply or adapt the pill card format on the AHRQ site (or other site) to your pharmacy. Alternatively, use the MTM Core Elements toolkit to create a medication record for patients (go to link below). Work with pharmacy leadership and staff to consider how use of the pill card might be integrated into pharmacy workflow. Write up your project plan and results and include your reflections on the process.

Faculty Note: Depending on the requirements of a pharmacy or residency project and the anticipated scope of the student/resident's project, this activity may need to be augmented.

Evaluation Criteria: For the assignment or experiential education, the student should have accurately transcribed the hypothetical patient's or the real patient's regimen into one of the pill card or medication record tools. Also the student should have used appropriate terminology (e.g., lay terms, no jargon) to help the patient understand his/her regimen and how to use the pill card. For the project, the student/resident should effectively adapt a pill card/medication record format into the pharmacy workflow, having worked closely with pharmacy leadership. The student/resident's report should summarize the plan, results and experience with the process.

Relevant PowerPoint® Slides:

Resources:

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