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GUIDELINES TO THE
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r.abdel-tawab@brighton.ac.uk
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Table of Contents
Introduction.................................................................................................................................... 3
A. Introduction ........................................................................................................................ 10
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Introduction
The purpose of this document is to provide guidance on the use of the medication-related
consultation framework. The framework is designed to teach and evaluate the consultation skills
knowledge, skills and attitudes when applied to a particular consultation will lead to a given
medication-related consultations. The competencies are evidence based and are considered to
care practitioner. It is not designed to address all possible consultation and communication
problems that a practitioner might encounter in everyday practice (e.g. anger management,
To provide the learner with a sense of purpose for learning consultation skills;
behaviours. The tasks are set out in a logical sequence, providing a structure to the
consultation, but this is not necessarily the order in which they will be tackled in each
consultation. The framework should therefore be seen as flexible and not as a script.
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health-care practitioner and a patient undertaking a therapeutic review. The purpose of such a
actual drug related problems, and to develop, with the patient, a plan for their resolution. The
emphasis lies on patient-centeredness, meaning that the practitioner works with the patient as a
co-worker.
The competencies included in the framework can be flexibly used in different contexts where
practitioners are conducting therapeutic reviews. This applies to settings ranging from
The framework is designed to support the practice of both students and practitioners alike,
involved in medication-related consultations and who wish to improve their consultation skills. It
The framework is divided into five distinct sections, with the first four (A to D) focusing on the
content of the consultation (i.e. what should be covered). The final section (E) focuses on the
consultation behaviours which underpin the consultation process (i.e. how the practitioner
progresses through the consultation). A summary of the main framework sections and the
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Section Aim
(A) Introduction Building a therapeutic relationship
(B) Data collection & Problem Identification Identifying the pharmaceutical needs
(C) Actions & Solutions Establishing an acceptable management plan
(D) Closing Negotiating safety netting strategies
(E) Consultation behaviours Note: section E is different to the other sections in that it
includes consultation behaviours that should be applied by
the practitioner throughout the entire consultation, as
opposed to consultation activities that are specific to a
particular section.
(1) An introduction phase, whereby the practitioner engages with the patient; (2) a data
gathering phase, whereby relevant information is obtained from the patient followed by an
resolve the problems identified and to negotiate shared management strategies; and finally (4) a
closing phase whereby the practitioner (i) determines whether the patient needs additional
information, (ii) discusses contingency plans in case something goes wrong and (iii) negotiates
follow-up plans. A summary of the competencies included in the framework is provided in Table
2.
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Table 2 A Summary of the Medication-Related Consultation Framework Sections & Corresponding Competencies
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An example of the basic structure of the framework is provided in Figure 1. This describes the
heading of the framework section, the competencies included under the heading and the
different rating scales that are available for evaluation and assessment purposes.
Did the practitioner undertake the following activities? 1 = not at all, 2 = touched upon; 3 = adequate; 4 = very good; N/a = not applicable
A. INTRODUCTION 1 2 3 4 N/a STRENGTHS
A1. Introduces self to patient
0 1 2 3 4
GLOBAL RATING: The practitioner was not able The practitioner was partially The practitioner was fully able
to build a therapeutic able to build a therapeutic to build a therapeutic
relationship with the patient relationship with the patient relationship with the patient
Overall the practitioners ability to Poor Borderline Satisfactory Good Very good
consult was:
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The assessment of individual competencies is on a 4 point scale ranging from not at all,
touched upon, adequate, and very good (Table 3). Some competencies may not be
relevant in every type of consultation and can therefore be marked as not applicable (n/a).
Global rating scales are included at the end of the individual framework sections A to D.
These ratings are intended to assess whether the overall aim of each individual framework
section was achieved. This is measured on a 5 point scale with the middle and extreme points
anchored by explicit descriptors; and ranges from fully, partially, not achieved.
This allows for a final reflective assessment of the entire consultation and the assessment is
on a 5 point scale ranging from poor, borderline, satisfactory, good and very good
In addition to above rating scales a comment box is provided that gives the evaluator the
option to provide the learner with more specific feedback about his/her strengths and
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The following is a guide of how to assess an individuals consultation skills against the three
The individual rating scale gives the evaluator the opportunity to assess each individual
competency (A1 A6) on a 4-point scale. In the example provided the practitioner showed an
adequate competence of introducing him/ herself (A1) and confirming the patients identity
(A2), was very good in discussing the purpose and structure of the consultation (A3), but had
only shown signs (i.e. 2 = touched upon) to invite the patient to discuss his/ her health
related issues (A4) and to negotiate a shared agenda (A5). Since this specific consultation did
not require the practitioner to pay attention to comfort and privacy (A6) this competency was
rated as not applicable (n.a.). The evaluator may find it helpful to make notes in the
The global rating scale for each individual framework section gives the evaluator the
opportunity to provide a score for the entire framework section, reflecting on the individual
ratings of each competency in the particular section. In the example (Figure 1), the evaluator
introduction that the practitioner was partially able to build a therapeutic relationship with the
patient.
Finally, to provide a final rating score for the entire consultation the evaluator needs to
consider and reflect upon the global rating score for each section. When selecting a
category, he/she should attempt to consider the overall performance in the context of
achieving the desired patient outcome. In doing so, the consultation skills of the practitioner
assessed in the example were considered to be satisfactory as indicated by the final rating
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section. In addition, quotes are provided to clarify the meaning behind some of the
competencies. These quotes are not to be understood as instruction; rather they are intended
A. INTRODUCTION
The aim of this section is to establish a therapeutic relationship with the patient.
This is understood as a relationship between a practitioner and a patient, where the patient is
encouraged to actively involved in his/ her own care if they so wish. This involves the
This is an important step in the pharmaceutical care process as it may strongly influence the
ability of the practitioner to gather information and to make appropriate decisions regarding
the nature of the patients real problem and methods to resolve these problems.
The opening statement between the practitioner and the patient sets the stage for the
interaction. Welcoming the patient and establishing friendly eye contact conveys confidence
For example:
Hello my name is and I am a pharmacy student form the University of Brighton. Hello my
name is I am the pharmacist running the clinic here today or I am your ward pharmacist.
A2. Confirms patients identity (e.g. name plus address or date of birth)
This is to ensure that the correct patient is receiving the correct medication and/ or advice.
The way how this is achieved depends on the situation, e.g., if a patient fills a prescription
then it is necessary to ask for a patients name and it is recommended to ask for one other
detail to make sure it is the right patient. If the patient is already known to the practitioner or if
the client is asking for general advice in a community pharmacy, then this task will be rated as
not applicable.
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The competencies A3, A4 and A5, below, are all concerned with the concept of shared
agenda setting, which means that the patient and the practitioner agree on a plan for the
consultation, i.e. what issues are to be discussed in the time available, in what order etc. As
A3. Discusses purpose and structure of the consultation (i.e. shares pharmacists
The practitioners agenda. The practitioner explains what issues/ objectives s/he would need
to cover in the consultation in order to fully assess a patients therapeutic needs. The
practitioner is expected to explain to the patient what s/he is planning to do and why s/he
would need to discuss certain issues, and approximately how long the consultation would
take.
This may involve for example, To make sure that you get the most benefit from your
medication I need to ask you a few questions about what medicines you are currently taking
and how you usually get on with your medicines. I can assure you that everything we discuss
will remain confidential and will only be used to help us both make decisions about your
health care. Would that be all right with you?
A4. Invites patient to discuss medication and/or health related issues (explores
patients agenda)
The patients agenda. The practitioner is expected to actively seek to involve the patient in the
consultation by inviting the patient to discuss any immediate medication-related and/or health-
related issues. Simply telling the patient what the practitioner is planning to do is not setting a
shared agenda.
For example:
Before we start is there anything that you would like to discuss with me? Or: Is there anything
about your treatment that you are particularly concerned about that you would like to discuss
with me?
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Negotiating a shared agenda means that a balance is found between the patients needs
and the practitioners objectives for the therapeutic review. Patients who feel that their
priorities are not addressed tend to be passive and not engaged in the consultation, hence
rendering the consultation less effective and practitioner-centred. Whereas the negotiation of
a shared agenda gives a clear structure to the consultation, and both parties know what is to
be discussed, in what order and both have the chance to amend the agenda if necessary.
If the patient does not, at this moment in time, raise any issues, a preliminary agenda can be
set. The practitioner doesnt need to repeat the structure if it was already discussed in A3
above; however the patient should be invited to interrupt the practitioner and to raise any
issues they would like to address during the consultation. The practitioner could use a
Fine so if there is nothing you would like to ask me right now, how about we start with
Please feel free to interrupt me if there is anything that comes to your mind that you would like
to ask me or if anything is unclear.
There are different situations in which a medication-related consultation can take place, but
whatever the situation the practitioner needs to pay attention to (1) the patients comfort and
Comfort entails issues such as making sure the patient is comfortable sitting or standing (as
appropriate); that the patient understands what the practitioner is saying in terms of clarity,
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tone of voice, pitch, or language; or whether the patient has eye-sight problems. Distance and
posture between patient and practitioner can influence whether a patient is feeling relaxed
and interested in the interaction. For example, if the practitioner is talking to a child,
Privacy is an important condition for effective consultations. This includes giving the patient
a space where s/he feels that s/he has the full attention of the practitioner, without other
patients or staff listening. It may not always be possible to move into a consultation room, but
moving to a less crowded area or pulling the curtains around a hospital bed shows the patient
that s/he has the practitioners full attention and that same attempt has been made to respect
Before I ask you about your medication, I want to check whether youre comfortable to
continue?
This also shows that, the practitioner is interested in ensuring that important pre-requirements
for the consultation are met (such as the patients ability to see or hear) and shows that the
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The aim of this section is to identify the patients pharmaceutical care needs.
information from the patient which is necessary for a thorough therapeutic assessment with
The information obtained from the medication history provides the foundation for planning
optimal medication regimens for the patient. This involves the practitioner enquiring about the
following issues:
B2. Assesses patients understanding of the rationale for prescribed treatment (i.e.
does patient know why treatment is prescribed and the likely benefits of
treatment)
This competency serves several purposes. It allows the practitioner to perform a baseline
assessment of what the patient already knows about his/her medicines, in what detail the
patient is informed about the medicines, and whether the patient thinks that the medicine is of
benefit to him/her. It also helps to determine whether the patient holds any misconceptions
about his/her treatment. In short the practitioner explores whether the patient has a clear
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This again allows the practitioner to establish what the patient already knows about his/her
illness and whether the patients understanding of his/her illness is consistent with their
doubts about the necessity or benefits of prescribed treatment or if the patient showes lack of
For example:
Perhaps could you tell me what (e.g. angina) means to you?
B4. Elicits concerns about treatment (e.g. beliefs about potential risks or side
effects)
This competency allows the practitioner to identify what concerns a patient may hold about
their medicines. It could be that the patient has already stated what the concerns are, when
s/he was asked about his/her understanding about the medicines and the illness. However, it
is necessary that the practitioner acknowledges those concerns, simply listening to the patient
volunteering that information does not demonstrate a practitioners competence to fulfil this
task.
For example:
You mentioned that you were worried that taking antibiotics may affect your bodys response
to them in the future. Are there any other worries that you have about the medicines youve
been prescribed?
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B5. Explores social history (alcohol, smoking, lifestyle, social support marital
lifestyle)
These are all issues that can interfere with a patients success to follow prescribed treatment.
The practitioner should consider those factors for both diagnostic decision-making and
therapeutic planning. However, it is important that these questions are asked in such a way
that does not compromise the patient-practitioner relationship and that they are introduced in
For example:
As you know, some medicines interfere with alcohol for example. Do you mind if I ask how
much alcohol you normally have?
Illness management
Taking a detailed account of the patients symptoms and establishing whether the experience
of these symptoms either remains the same, or improves or worsens when following
treatment advice, gives the practitioner an additional indication of (i) whether the patient is
responding to prescribed treatment; and (ii) what the patient may think about the necessity for
prescribed treatment.
For example:
Are you finding it helps the symptom or condition being treated?
Have you noticed anything unusual or out of the ordinary while taking this?
B7. Asks how patient monitors the illness (e.g. peak flow, BP measurement etc.)
This competency may not be relevant for every clinical situation, but for example asking a
diabetic patient how s/he checks his/her glucose levels and what the findings are provides
important information about (i) a patients understanding of his/her illness and (ii) how well the
illness is controlled.
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To undertake physical assessments is a fairly new skill for pharmacy practitioners. In order to
appropriate physical assessment. This may include for example to measure the blood
Adherence assessment
The following three competencies B9, B10 and B11 are concerned with the concept of
especially if non-adherence is not identified and the practitioner believes that the patient is
Questioning regarding non-adherence can be difficult, because most patients feel guilty or
The use of statements which acknowledge that many people find it difficult to follow
medication regimes or forget to take medication may encourage the patient to respond
truthfully.
For example:
Many people have difficulty remembering to take every dose of a medication thats been
prescribed several times a day. Whats your experience?
If non-adherence is identified the practitioner should determine the reason for non-adherence
so that it can be corrected, if possible. The reasons could range from forgetting to take
medication, experiencing side effects, having difficulties reading labels or opening containers,
having difficulties paying for prescription fees, poor comprehension of the need for treatment
or strong concerns about the perceived risks associated taking specific medication.
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B11. Explores patients attitudes towards taking medication (e.g., asks whether
It is well established that some patients have difficulties telling their doctor that they do not
want to take medication for their diagnosed problems. Therefore, to determine whether the
patient wishes to take medication for their illness is an important issue. This could (i) help
identify misconceptions the patient may hold about their illness, or (ii) highlight the need to
consider other management options that may help alleviate the patients condition.
For example:
Tell me more about why you dont like taking medications?
It sounds like you dont think that your problem is serious enough to need medication.
It sounds like you dont think the medicine will help you.
B12. Asks how much/ what information patient wants before discussing solutions
to patients needs
This is a competency that clearly shows whether the practitioner tailors the consultation to the
individual patient. This involves actively finding out what the patient wants to know (relating to
what they already know, which should ideally have been identified earlier, by previous
competencies); followed by what more they want to know. This reduces the risk of providing
a one size fits all approach to information provision, and from missing issues that are
For example:
It would be helpful for me to understand a little of what you already know so that I can try to
fill in any gaps for you
Theres a lot more information that Id be happy to share with you about your medicines.
Some patients like to know a lot about these things and some prefer to keep it to a minimum
how much information would you yourself like?
Patients vary in the extent to which they wish to be involved in decisions about treatment and
in planning future management. A patient who does not wish further specific information
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(B12), does not necessarily want to be left out of decisions about treatment management and
vice versa.
For example:
When we discuss how best to manage all your medications, would you like me to go through
some options that we have, or would you like me to decide what I think is the best choice for
you?
Problem identification
This competency describes that stage of a consultation where the practitioner analyses the
information gathered and determines whether the patient is experiencing any medication-
related problems and whether the patients health outcomes are being met. The
patient. This is best achieved by summarising what the identified problems are. This serves
two purposes, (i) it actively involves the patient in the consultation by overtly clarifying what
the practitioner is thinking; (ii) it is advantageous to both parties because this process gives a
clear structure to the remainder of the consultation and avoids important issues from being
missed.
This competency serves the same purpose as the competency negotiating a shared agenda
(A5) in the introduction sequence of the consultation. After having completed the data
collection phase, new issues or problems that need to be discussed may have emerged and
therefore priorities for discussion of pharmaceutical problems may have changed. In order to
continue the consultation as a two-way process and to keep the patient actively involved, the
agenda for the next sequence in the consultation needs to be overtly negotiated with the
patient.
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The overall aim of this section is to establish an acceptable management plan with the
patient.
In cases where actual or potential pharmaceutical problems were identified, the practitioner
and patient are expected to work jointly on a plan for their resolution.
This is a key patient-centred skill, which is also referred to as reactive explanation. A pre-
requirement to this task is that the practitioner has actively explored the patients
understanding about his/her illness and medication, about lifestyle issues or any other issues
that may influence the patients medication taking behaviour. Reactive explanation means
that the practitioner combines the patients own beliefs and theories with the practitioners
understanding of the patients problems and if applicable, gives reasons why the practitioners
theory is different to the patients. This task also means that the practitioner tailors his/her
information specifically to the patients life-style and social situation as opposed to a one size
C2. Involves patient in designing a management plan for identified problem(s) (e.g.
As it is ultimately the patient who needs to take responsibility for his/her illness the practitioner
needs to clearly state all possible options that could be undertaken to solve the
pharmaceutical care problems identified. The execution of this competency allows the patient
to be actively involved in decision-making to the extent that the patient wishes to be involved.
The practitioner needs to review all available options with the patient. The patient should then
be allowed to decide what s/he prefers and is willing to do. This process is contrary to a
practitioner-centred practice where the patient is confronted with a plan that s/he might find
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C3. Gives advice on how & when to take medication, length of treatment &
This competency is self-explanatory; the practitioner is expected to give clear and detailed
instructions to the patient. The negotiation of a follow up is necessary to ensure that the
patient is gaining the anticipated benefits from the medication and if not to discuss alternative
options.
For example:
When youre in pain, take them every 3 to 4 hours. Its best to take them with food or milk so
that the aspirin wont upset your stomach.
C4. Checks patients ability to follow plan (i.e. does patient anticipate any problem
ability)
Once a management plan has been established with the patient, it is important to ask the
patient whether s/he would anticipate any problems that would make it difficult to follow the
management plan and then to ask the patient whether s/he can think of possible solutions.
For example, these problems can range from motivation issues (e.g. the patient does not
want to take medication); resource issues (e.g. the patient cannot afford to pay for the
medication); or time issues (e.g. the patient may have unfavourable working conditions which
This competency is one of the most important competencies to achieve in a consultation. This
severs to determine whether the patient will be able to follow treatment advice and therefore
receive anticipated benefits of treatment. It is neither sufficient simply to assume that a patient
has understood and remembers all important information nor to say is that ok? without any
further checking.
For example:
I would like to make sure that I have covered everything and explained things well enough,
so may I ask you to tell me in your own words, how you will use this medication.
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Checking understanding has to be sensitively undertaken to avoid causing the patient to feel
However, not checking the patients understanding at all may mean that patients could leave
This competency includes the discussion of health promotion issues, such as e.g. smoking
After allowing the patient to consider the information that s/he has received, it is important that
the practitioner finds out whether the patient needs additional information or explanations
For example:
Is there anything else you want to know about your medicines and how to monitor whether
they work?
This involves the practitioner to recognise personal limitations and professional boundaries
(work within the professional code of ethics) and to refer to appropriate other health care
professional if necessary.
For example:
If this continues on for X number of days, or seems to get worse then see your doctor.
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The aim of this section is to negotiate safety netting strategies with the patient.
This allows the practitioner to plan for possible unwanted deviations from the negotiated
management plan and to discuss with the patient what steps to undertake if things go wrong.
D1. Explains what to do if patient has difficulties to follow plan and whom to
contact
The practitioner needs to discuss with the patient what if the patient is having difficulty
following the management plan; or if the patient is experiencing unwanted effects and what
action the patient could take in the event that things do not go as planned.
For example:
If you have any questions or problems, dont hesitate to call us.
Would you give me a call tomorrow to let me know how you are doing with the medication.
The practitioner should encourage further appointments to check whether the medication is
effective and is being used appropriately. Or in cases where it was decided to opt for no
medication, the patient should be invited to discuss other possible interventions in case the
D3. Offers opportunity to ask further questions with regard to issues discussed in
the consultation
This gives the patient a final opportunity to raise any issues that s/he would need clarified.
For example:
Do you have any more questions about anything we have discussed here today?
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E. CONSULTATION BEHAVIOURS
E1. Listens actively & allows patient to complete statements without interruption
Active listening demands concentrated efforts to fully listen to a patients viewpoint. In active
listening there are clear indicators that show whether the message is coming across; these
include verbal facilitating statement such as Mmm, go on.., repetition of the last words the
patient was saying; as well as non verbal signs, such as keeping eye-contact, nodding, facial
expressions and gestures. By listening actively the practitioner encourages the patient to
The opposite is passive listening, whereby the listener shows no sign of actually hearing
what the other person is saying. At worst they may look bored or distracted and there is no
sign that what one participant was saying was actually heard.
The practitioner asks questions that are significant for the identification of a patients
pharmaceutical care needs as opposed to questions that are confusing to the patient,
jeopardise the therapeutic relationship or do not fit logically to the therapeutic assessment.
Open-ended questioning techniques invite the patient to respond with a narrative and do not
restrict the answer in any way, while still directing the patient to a specific area of enquiry.
For example:
How have you been feeling since you started the new medication?
What medication are you currently taking?
How do you take your medication?
Closed-ended questioning techniques, or direct questions, ask for specific information and
details. The patient usually responds with short one- to two- word answers, such as yes or
no.
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For example:
Both techniques are essential for effective communication. However, a combination of open-
ended questions, gathering less structured information first, and moving to closed-ended
questions, eliciting specific details about a patients problems, are considered to be most
useful. This is also described as the open-to-close cone. Overusing closed-ended questions
may give the patient the impression of being interrogated; the patient may become passive
Practitioners should avoid using jargon or medical terminology or in cases where jargon is
used the practitioner needs to explain what the terminology means. It is important that
practitioners communicate with the patient at the appropriate education level and adapt their
language level to that of the patient. Talking over the patients head does not encourage a
This again is key when building a trusting relationship with a patient. Accepting the patient
means that the practitioner acknowledges a patients problem or life-story without expressing
behaviours. This does not mean that a practitioner necessarily agrees with the patient, but it
enables the practitioner to understand the patient and avoids putting the patient in a defensive
position. Examples of unhelpful criticism are judging a patient who smokes; judging older
background.
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E6. Demonstrates empathy with and supports patient (e.g. expresses concern,
Empathic responses tell the patient that the practitioner is trying to understand the patients
situation and concerns and is another fundamental behaviour when building a therapeutic
relationship with a patient. The expression trying to put oneself into another persons shoes
practitioner needs to show that s/he is trying to understand how the patient is feeling and to
This may involve a number of different situations that patients may find difficult to talk about.
or impotence.
Other disturbing topics may involve issues regarding medications for life threatening diseases
or terminal illnesses.
E8. Shares thinking with the patient (when appropriate) to encourage patients
This again personalises the consultation and may encourage the patient to participate. The
practitioner lets the patient know what his/her thought processes are and how they relate to a
patients problem, as opposed to providing the patient with facts that might not make common
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E9. Uses information from test results to inform decision making and to explain
treatment option(s)
This refers to clinical situations where for example a diabetic patients blood sugar control is
understand what INR (International normalised ratio) means, or how well the blood pressure
For example:
Looking at your blood results confirms what you have told me about the missed doses of
medicines
This applies to the principles of evidence-based medicine. The competency shows whether
problem that is being discussed and whether the practitioner uses this information
appropriately to improve the patient understanding of his/ her illness and treatment. This may
not be relevant to every patient or to every clinical situation, because in many practice
situations clear evidence may not be available, or it may not be appropriate to overload the
The use of skills like agenda setting, summarising and signposting allow the practitioner to
follow a clear logical process and to tailor the consultation to the individual patient.
Avoids the patient from wandering off unnecessarily, the practitioner leads the consultation
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For example:
I am really sorry to hear about the difficulties your friend has had but I wonder if we
might go back to the point when you said your breathing had started to get
worseparticularly when you had forgotten to take your water tablets?
E13. Manages time effectively (works well within the time available)
This competency focuses on the practitioners ability to make effective use of the time
available. This included a judgement on whether or not the practitioner conducted a thorough
consultation and identified the pharmaceutical care needs of the patient within the time limits
of the consultation. Furthermore, this includes a judgement on whether or not the overall
consultation needs were met, and whether the consultation was rushed, prolonged
valuable communication tool for future encounters with a patient and also provides helpful
information for the patients other health care professionals. In the assessment process a
pharmaceutical care plan allows to assess a practitioners problem solving skills and
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APPENDIX 1 MEDICATION-RELATED CONSULTATION FRAMEWORK Formatted: Font: 9 pt, Not All caps
Did the practitioner undertake the following activities? 1 = not at all, 2 = touched upon; 3 = adequate; 4 = very good; N/a = not applicable
A. INTRODUCTION 1 2 3 4 N/a STRENGTHS
Formatted: Font: (Default) Arial Narrow, 9 pt, Bold
A1. Introduces self to patient Formatted: Normal, Space Before: 3 pt, After: 0 pt
Formatted: Font: Arial Narrow, 9 pt
A2. Confirms patients identity (e.g. name plus address or date of birth)
Formatted: Bullets and Numbering
A3. Discusses purpose and structure of the consultation (i.e. shares pharmacists agenda Formatted: Bullets and Numbering
with the patient)
Formatted: Bullets and Numbering
WEAKNESSES
A4. Invites patient to discuss medication and/or health related issues (explores patients Formatted: Bullets and Numbering
agenda)
A5. Negotiates shared agenda (prioritising issues to be discussed considering Formatted: Bullets and Numbering
pharmacists objectives & patients needs)
A6. Pays attention to comfort and privacy Formatted: Bullets and Numbering
0 1 2 3 4
GLOBAL RATING: The practitioner was not able to The practitioner was partially The practitioner was fully able to
build a therapeutic relationship able to build a therapeutic build a therapeutic relationship
with the patient relationship with the patient with the patient
2003 Abdel Tawab, R.; James, D.; Davies, G.; Horne, R. School of Pharmacy & Biomolecular Sciences, University of Brighton. Please do not reproduce without
permission. r.abdel-tawab@brighton.ac.uk
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Did the practitioner undertake the following activities? 1 = not at all, 2 = touched upon; 3 = adequate; 4 = very good; N/a = not applicable
B. DATA COLLECTION & PROBLEM IDENTIFICATION 1 2 3 4 N/a STRENGTHS
B1. Documents full medication history
Prescribed medication, frequency, dose, duration of course, route of
administration
Allergies type/ nature
Drug sensitivities or intolerances, Adverse drug reactions
Self-medication (OTC, supermarket, etc.)
Complementary & alternative therapies (e.g. homeopathy, herbal medicines,
etc.)
Recreational drug use
B2. Assesses patients understanding of the rationale for prescribed treatment (i.e.
does patient know why treatment is prescribed and the likely benefits of treatment)
B3. Elicits patients (lay) understanding of his/her illness (this is particularly relevant if
patient is NOT clear about rationale for treatment)
B4. Elicits concerns about treatment (e.g. beliefs about potential risks or side effects)
B5. Explores social history (alcohol, smoking, lifestyle, social support, occupation, diet,
impact of medication on patients lifestyle)
Illness management
B6. Explores patients experience/ control of symptoms
WEAKNESSES
B7. Asks how patient monitors the illness (e.g. peak flow, BP measurement etc.)
B8. UUndertakes appropriate physical assessment (when indicated)
Adherence assessment
B9. Asks how often patient misses dose(s) of treatment
B10. Identifies reasons for missed dose(s) (unintentional or intentional)
B11. Explores patients attitudes towards taking medication (e.g., Aasks whether patient
wishes to be prescribed treatment?)
Exploring patients wish for involvement
B12. Asks how much/ what information patient wants before discussing solutions to
patients needs
B13. Asks how involved patient wants to be in decision making
Problem identification
B14. Identifies and prioritises patients pharmaceutical problems (by summarising the
identified pharmaceutical problems)
B15. Re-negotiates agenda (if necessary) (prioritising issues to be discussed considering
pharmacists objectives & patients needs)
0 1 2 3 4
The practitioner was not able to The practitioner was partially The practitioner was fully able to
GLOBAL RATING:
identify the patients able to identify the patients identify the patients pharmaceutical
pharmaceutical care needs pharmaceutical care needs care needs
February 2005 30
DRAFT COPY
Did the practitioner undertake the following activities? 1 = not at all, 2 = touched upon; 3 = adequate; 4 = very good; N/a = not applicable
C. ACTION/ SOLUTIONS 1 2 3 4 N/a STRENGTHS
C1. Relates information to patients illness & treatment beliefs (addresses information
gaps, communicates anticipated benefits & addresses concerns/ risks of
treatment)
C2. Involves patient in designing a management plan for identified problem(s) (e.g.
discusses options/ rationale)
C3. Gives advice on how & when to take medication, length of treatment & negotiates
follow up (if necessary)
C4. Checks patients ability to follow plan (i.e. does patient anticipate any problem WEAKNESSES
following the plan e.g. in terms of motivation, resources, time or physical ability)
C5. Checks patients understanding (e.g. invites patient to recap)
C6. Discusses lifestyle issues/ prevention strategies (health promotion issues)
0 1 2 3 4
GLOBAL RATING: The practitioner was not able to The practitioner was partially able The practitioner was fully able to
establish an acceptable to establish an acceptable establish an acceptable
management plan with the patient management plan with the patient management plan with the patient
Did the practitioner undertake the following activities? 1 = not at all, 2 = touched upon; 3 = adequate; 4 = very good; N/a = not applicable
D. CLOSING THE CONSULTATION 1 2 3 4 N/a STRENGTHS
D1. Explains what to do if patient has difficulties to follow plan and whom to contact
WEAKNESSES
D3. Offers opportunity to ask further questions with regard to issues discussed in the
consultation
0 1 2 3 4
GLOBAL RATING: The practitioner was not able to The practitioner was partially The practitioner was fully able to
negotiate safety netting able to negotiate safety netting negotiate safety netting strategies
strategies with the patient strategies with the patient with the patient
February 2005 31
DRAFT COPY
Did the practitioner demonstrate the following behaviours? 1 = not at all, 2 = poor; 3 = adequate; 4 = very good; N/a = not applicable
E. CONSULTATION BEHAVIOURS 1 2 3 4 N/a STRENGTHS
E1. Listens actively & allows patient to complete statements without interruption (i.e.
keeps eye contact, verbal acknowledgement, non verbal feedback)
E2. Asks relevant questions
E3. Uses open & closed questions appropriately
E4. Avoids or explains jargon
E5. Accepts patient (i.e. respects patient, Is not judgemental or patronising)
E6. Demonstrates empathy with and supports patient (e.g. expresses concern,
understanding, willingness to help, acknowledges coping efforts)
E7. Deals sensitively with embarrassing & disturbing topics
E8. Shares thinking with the patient (when appropriate) to encourage patients WEAKNESSES
involvement (if wanted)
E9. Uses information from test results to inform decision making and to explain treatment
option(s)
E10. Uses evidence based medicine-type information to inform decision making and to
explain treatment option(s)
E11. Adopts a structured & logical approach to the consultation
E12. Keeps interview on track or regains control when necessary
E13. Manages time effectively (works well within the time available)
E14. Provides logical and correct documentation
Overall the practitioners ability to consult was: Poor Borderline Satisfactory Good Very good
February 2005 32