Keys to caring for complex patients

The issue of providing proper pharmaceutical care to individuals with multiple disease states is one that continues to grow. As the population of the United States continues to age, as diagnostic screening methods improve, and as more individuals have better access to healthcare, pharmacists will encounter an increasing number of patients who require a more comprehensive approach to their treatment management.

In September I attended the annual International Pharmaceutical Federation (FIP) Congress. While there, I had the opportunity to attend a session titled “Complex patients and obstacles to quality use of medicines: A patient’s perspective.” This particular session addressed some of the challenges that arise in connection with these multifaceted individuals. Tara Hehir, a consultant pharmacist from Sydney, Australia, and Parisa Aslana from the University of Sydney led the presentation.

Complex patients

For the purposes of this discussion, a complex patient was defined as someone with any of the following characteristics: multiple medications or disease states, comprehension difficulties, physical or mental disabilities, or psychological issues. Patients with multiple disease states can have highly complicated regimens that may be difficult to manage. These patients often require a more individualized approach, one that is tailored to their needs. 

Aside from the challenges of handling the various health issues of complex individuals, in dealing with them we may also face communication barriers. Complex patients are more likely to have issues with vision, hearing, or cognition. In addition, they may have psychological issues that need to be acknowledged.

Often when their physicians assess them, patients receive only the basic details about their conditions and disease progression. When they are given information, it may be too complicated or technical for them to grasp fully. Perhaps only one or two treatment options are suggested, when there may be as many as a half dozen options available. Sometimes the healthcare providers of such patients may be overwhelmed and find themselves “too busy” to fully address their patients’ concerns.

Communication factors

This is where we as pharmacists have the ability to step in and help fill some of the communication gaps.

Here’s the payoff: When we deliver accurate information to our patients in a manner they can use, good things happen. Increased interventions mean increased medication adherence. This in turn results in better health outcomes, leading to a reduction in healthcare costs.

When we take the time to present information to a patient, it is critical that we be aware of the manner in which we present it. It is also important to understand that we may not be the first healthcare provider the patient has spoken with on any given day. And in delivering information, we need to assess the patient’s current level of understanding in regard to the condition in question.

Depending on the patient, the language should not be overly technical.

We should convey important information in a manner that is not rushed. When we hurry the message, it can often make our patients feel as though they, or their conditions, are not important to us. Take the time to answer any questions or respond to concerns.

Lastly, the counseling environment should be free of distractions and comfortable for the patient. Treat your patients as you would treat your own grandmother.

An active role

The take-home message from this is that we as pharmacists need to take an active role in communicating with our patients and their other healthcare providers.

We do this by explaining the specific purpose of each medication. We inform the patient of any adverse side effects that may occur in connection with a particular treatment. And we need to communicate effectively with the various providers in order to gather all the information needed to complete the patient picture.

This may all seem like common sense. It may seem as if these are all parts of our job description, but sometimes it’s necessary to take a closer look at our process.

There is no “one size fits all” approach to dealing with complex patients. Each case needs to be examined on an individual basis. Every situation and patient is different, and what may work for one person may fail miserably for another. By keeping an open mind and an open dialogue, we can often make a very real difference to our patients and their outcomes.

Most important is to always be mindful, to use common sense, and to show sensitivity toward the patients: If you were in their shoes, how would you like to be cared for?

Joel Claycombreported on last year’s FIP Congress in the December 2012 and February 2013 issues of Drug Topics. Contact him at jcclaycomb@gmail.com.