a meta-narrative review of recorded patient–pharmacist interactions: exploring biomedical or...

Research in Social and

Administrative Pharmacy j (2013) j–j

Review Article

A meta-narrative review of recordedpatient–pharmacist interactions: Exploring biomedical

or patient-centered communication?Muna S. Murad, M.Sc.a,

Trish Chatterley, M.L.I.S.b,Lisa M. Guirguis, M.Sc., Ph.D.a,*

aFaculty of Pharmacy and Pharmaceutical Sciences, 3-171, Edmonton Clinic Health Academy, University of Alberta,

11405 87 Avenue, Edmonton, Alberta, Canada T6G 1C9bJohn W. Scott Health Sciences Library, University of Alberta, Canada

Abstract

Background: Pharmacists worldwide require improved patient-centered communication skills as they

transition from a dispensing role to enhanced involvement in patient care. Researchers have studiedpharmacist communication through audio and video recordings of patient–pharmacist encounters. Ameta-narrative review of research using these recordings will offer insight into the extent of biomedical vs.

patient-centered communication in patient–pharmacist exchanges.Objectives: This review aimed to characterize research on patient–pharmacists interactions using audio orvideo recordings and explore the 1) focus of research questions, 2) study design, 3) data analysis methods,4) main findings and 5) presence of patient-centered vs. biomedical models of interaction.

Methods: Drawing on the principles of meta-narrative systematic review, a literature search was performedto identify studies published in English. No publication date limits were implemented. Key search termsincluded: “audio recording”, “video recording”, “communication”, “patient counseling”, “patient

interaction”, “discourse analysis”, “conversation analysis”, “narrative analysis”, and “content analysis”.The search was conducted in five databases: Medline, Embase, International Pharmaceutical Abstracts(IPA), Web of Science, and Academic Search Complete.

Results: Forty-one articles met the inclusion criteria and represent 32 unique collections of patient–pharmacist recordings. The 23 quantitative studies focused on “what” was in the interaction, whereas the 5qualitative studies characterized specialized pharmacy practice and 13 studies used conversational analysis

to describe “how” patients and pharmacists interact. The majority of research described the content ofrecorded interactions in community pharmacies. Twenty-three studies presented evidence of a biomedicalmodel, whereas 8 studies characterized a patient-centered focus.Conclusions: A developing body of research used recordings to describe the content of patient–pharmacist

communication and explore the quality of the interactions, validation of coding tools, impact of anintervention, and patient–pharmacist power asymmetry. Study findings, particularly the identification of

* Corresponding author. Tel.: þ1 780 492 9693; fax: þ1 780 492 1217.

E-mail address: [email protected] (L.M. Guirguis).

1551-7411/$ - see front matter � 2013 Elsevier Inc. All rights reserved.

http://dx.doi.org/10.1016/j.sapharm.2013.03.002

Delta:1_given name

Delta:1_given name

Delta:1_given name

Delta:1_surname

Delta:1_given name

Delta:1_given name

Delta:1_given name

Delta:1_surname

Delta:1_given name

mailto:[email protected]

http://dx.doi.org/10.1016/j.sapharm.2013.03.002

2 Murad et al. / Research in Social and Administrative Pharmacy j (2013) 1–20

biomedical vs. patient-centered communication, were guided by the quantitative, qualitative, orconversational analysis research paradigm.� 2013 Elsevier Inc. All rights reserved.

Keywords: Audio recordings; Video recordings; Patient centered care; Patient–pharmacist interactions; Biomedical

Introduction

Evidence demonstrates that pharmacists’ care

enhances patient health.1 Pharmacy practiceworldwide is evolving from dispensing and educat-ing patients to providing patient-centered care

where pharmacists assess the appropriateness ofmedication therapy, ensure patients have an un-derstanding of their drug therapy, encourage ad-

herence to medications, and monitor patientoutcomes.2 In the pharmacy literature, patient–pharmacist communication has been conceptual-ized as a transmission action or a transaction.3

Transmission is a one-way process from sender toreceiver. Biomedical communication usually fol-lows a transmission model where the pharmacist

concentrates mainly on providing medication-related information. The transaction model isa two-way process, where shared meaning is nego-

tiated between two participants such as in patient-centered communication where the pharmacistidentifies and responds to patients’ ideas and emo-tions regarding their illness.3

The main difference between the patient-centered and biomedical models is the level ofpatient engagement.4 The biomedical model en-

hances the control and status of the pharmacist,whereas the patient-centered model enhances thecontrol and status of the patient. During biomed-

ical communication, the pharmacist focuses onthe treatment of the disease with little attentiongiven to the role of psychological or social influ-

ence.5 In the patient-centered model, the patientcollaborates with the pharmacist to: 1) identifytreatment goals; 2) choose from regimen options;3) monitor symptoms and evaluate regimens;

and 4) revise regimens if problems occur.6 In thepatient-centered model, the pharmacist works di-rectly with a patient and in conjunction with other

practitioners to take responsibility for achievingthe optimized outcomes of drug therapy.7 It in-volves the development of an individualized care

plan to achieve the intended goals of therapywith appropriate follow-up to determine patientoutcomes.8 Several studies have found an associa-

tion between patient-centered communication and

increased patient satisfaction, treatment adher-ence, improved medical outcomes, and decreased

number of malpractice claims.9–14

To transition to patient-centered care, phar-macists require strong communication skills.15

Two recent review articles have examined pa-tient–pharmacist communications. Shah andChewning found that research has focused on

one-way communication from the pharmacist tothe patient.3 Puspitasari et al took an interna-tional perspective and found pharmacist counsel-ing rates vary worldwide from 8% to 100%,

with more counseling for new rather than refillprescriptions.16 Pharmacists more routinely pro-vided information on directions for use, dose,

medication name, and indications than on side ef-fects, adverse events, and storage.16 Both studiesreported diverse research methods with a focus

on self-report surveys, non-participant observa-tion, interviews, and shopper studies that werecross-sectional in nature. These studies frequentlyfocused on the pharmacist and did not capture ac-

tual patient–pharmacist interactions. Shah andChewing reported only one audio analysis thatwas conducted by Blom et al17 Puspitasari et al

mentioned the same research in addition to a studyby Evans and John18 and Livingstone.19

An analysis of patient–pharmacist recordings

would allow for detailed study of patient-centeredcare. Audio or video recordings of patient–pharmacist interactions can capture the detail

of what happens in real interactions betweenpatients and pharmacists, how these interactionstranspire, and provide evidence as to why com-munication occurs.20 Standardized questionnaires

and interviews test hypotheses by measuringpre-specified constructs. Respondents constructa belief or attitude that may vary in differing situ-

ations.21 Qualitative interviews allow for greaterexploration, but as with structured surveys, relyon recall of events. Observational research with

simulated patients (e.g., pseudo-patients, secretshoppers) or pharmacy observations have an im-portant role in determining “what” happens in

a patient–pharmacist interaction whether it is the

3Murad et al. / Research in Social and Administrative Pharmacy j (2013) 1–20

implementation of a new technique or content ofpharmacists’ advice.22 Mesquitta found that phar-macy research using simulated patients did notdefine and therefore could not measure patient–

pharmacist communication skills or competencies.22

Patient–pharmacist audio recordings allow forunique study of how or why patient–pharmacist

interactions take place; this research is notpossible with other methods. “Examining patient–pharmacist communication as an interpersonal

dyadic interaction may help us understand col-laborative problem-solving activities, and interper-sonal relationship development within the context

of mutual trust, rapport, and familiarity betweenthe participants.”3

There is an emerging body of research thatused recordings of patient–pharmacist interac-

tions as a data collection method and wanted todetermine how this research technique has beenemployed in pharmacy practice research. The

analysis of recordings uses a variety of methodsfrom quantitative coding of the interaction,qualitative inductive methods, and discourse

analysis.20 Discourse analysis is a methodologicalapproach that is often used in the study ofcommunication in health care consultations. It

involves the study of spoken and written lan-guage and how language use reflects social orderand individuals’ interactions within society.23

This technique focuses on turn-taking, repair of

conversation breakdown, topic managementand non-verbal behaviors. The analysis approachand resulting findings may characterize patient–

pharmacist communication as biomedical orpatient-centered. The current study used an ad-aptation of the meta-narrative review, which is

a coherent body of work that shares a commonset of concept, theories, methods and instrument,to present our results.24 Meta-narrative reviewsare best suited to study topic areas where existing

studies have been conceptualized differently and/or conducted by many different researchers. Theresearch using recordings from pharmacy prac-

tice arises from quantitative, qualitative and dis-course analysis traditions which influences howresearch has been conceptualized and designed,

and therefore also the key findings that result.This review aims to characterize the 1) focus ofresearch questions, 2) study design, 3) data anal-

ysis methods, 4) main findings, and 5) presence ofpatient-centered vs. biomedical models of inter-action in recorded patient–pharmacist interac-tions with attention to the influence of the

research tradition.

Methods

Data sources

A literature search was performed by a medicallibrarian to identify studies published in English.

No publication date limits were implemented.Searches were conducted in the following data-bases: Ovid Medline, Ovid Embase, InternationalPharmaceutical Abstracts (IPA), Web of Science,

and Academic Search Complete. Two differentapproaches were used to identify relevant studies:search terms related to patient–pharmacist en-

counters (such as “patient counseling” and “pa-tient interaction”) were combined with eithersearch terms related to the medium of collection

(i.e., audio or video recordings), or to searchterms about the method of data analysis (e.g.,“discourse analysis”, “conversation analysis”,“narrative analysis”, “content analysis,” etc.).

Keywords about the methods of data analysiswere added to include several articles that werefound in cited references and not on the first

electronic search. In addition, reference lists ofincluded articles where reviewed to identify addi-tional relevant studies. The search results are

shown in (Fig. 1).

Study selection

Two authors identified citations by screeningtitles and abstracts for potential relevance. Thefull text article for each potentially relevant

citation was obtained for further evaluation.Studies were eligible for inclusion if they examinedpatient–pharmacist interactions using audio or

video recordings, were published in English asa peer-reviewed full-text article, and used realpatients or simulated patients. Papers were ex-cluded that used pharmacy students and interns or

used audio or video materials solely for teachingpurposes. The full text articles were examined todetermine eligibility for inclusion; any discrep-

ancies regarding inclusion were resolved by dis-cussion. One author extracted details on researchquestion, method, analysis, and main findings and

a second author verified extraction.

Defining patient-centered vs. biomedical model

Studies were defined as patient-centered if thestudy specifically stated it measured patient-centeredness or if the pharmacists applied several

elements of patient-centeredness during their con-sultations with patients such as: incorporating thepatient perspective into treatment discussion,

Fig. 1. Search results.


active listening, asking open-ended questions, andverifying patient understanding.25–28 Articles rep-resenting the biomedical communication modellacked patient-centered elements or exhibited

pharmacists dominating the interactions with pa-tients playing a passive role. These studies oftenconcentrated on the content of counseling.

Results

The search identified 586 studies. Of these

articles, 162 were duplicates and additional 383articles were excluded after independent assess-ment by the two authors. Authors agreed on theallocation of all articles therefore 41 articles met

the inclusion criteria. These represent 32 uniquecollections of recordings. One study was publishedin the 1980s, 10 in the 1990s, 22 after 2000, and

eight after 2010. The research was predominatelypublished in the quantitative research paradigm(20 studies; Table 1) followed by qualitative re-

search (5 studies; Table 2) and discourse analysis(13 studies; Table 3). The remaining three studies(Table 4) used expert groups to develop criteria

for the quality of patient–pharmacist interactions(2 studies) or a mixed method approach (1 study).The following sections discuss the research ques-tions, study designs, data analysis, and findings

as conceptualized in each research tradition.

Research questions

The research questions were driven by the

research method. The quantitative research ques-tions (Table 1) can be categorized as 10 studies fo-cusing on the content of the interaction,17,18,29–35

4 on evaluating the quality of interactions witha validated tool36 or to validate a tool,34,37,38 twoon patient recall,39,40 two that test a hypothesis,41,42

one to evaluate an intervention,43 and one on vali-

dating the quality of stimulated patient recall.44

The five qualitative studies explored pharmacistsin new roles,25,45,46 maintenance of professional ex-

pertise47 and communication breakdown.48 The re-search in discourse analysis asks oneof twoprimaryquestions regarding either the structure of patient–

pharmacist communication or the exploration ofphenomena including acceptance of advice,49

conflict talk,50 patient expertise,51 compliance

Table 1

Quantitative studies

Author/year

reference No.

Research questions Method Analysis Main findings Biomedical/

Patient-centered

communication

Bentley et al41 To determine whether

pharmacists’ appearance

and communication impact

patient evaluations

(satisfaction, service

quality, trust and future

intention).

Online video: Videos of

patient–pharmacist

interactions were viewed.

Observers completed an

online survey, USA.

179 video recordings were

analyzed quantitatively.

A higher pharmacist

communication

performance (i.e., greater

attentiveness, information,

and patient involvement)

was associated with higher

pharmacist evaluations

while dress or presence of

white coat was not.

Biomedical

Bisell, Ward,

and Noyce29To determine the variations in

demand for, and response

to pharmacy-only

medicines requested.

Community pharmacies, UK.

Audio recordings of

pharmacists/medicine

counter assistants–patients

interactions. Non-

participant observation.

The transcripts were analyzed

quantitatively, n ¼ 427

requests.

Pharmacists were more likely

to provide advice than a

counter assistant. 70% of

interactions did not involve

a pharmacist. 10% solely

involved a pharmacist.

Rates of advice with

medicine sales ranged from

17 to 97% in 10

pharmacies. Patient

assessment was not

consistent.

N/A

Blom et al 17 To identify the content of

patient counselling.

Community pharmacies,

Netherlands. Audio

recording of patients-

pharmacists/technicians

contacts.

6784 recordings were

analyzed quantitatively

using a novel scoring

system.

Pharmacists provided advice

for 36% of prescriptions

that was focused on drug

instructions and not

solicited. Pharmacists

provided more oral

information than

technicians.

Biomedical

Cavaco and Romano30 To describe pharmacist-

customer communication

during blood pressure and

cholesterol services.


Portugal. Audio recording

of patient–pharmacist

interactions.

83 transcripts were analyzed

quantitatively using a

system adapted from

Roter Method of

The average of blood pressure

and cholesterol counseling

was 5:35 min and 7:05 min

respectively. In both cases,

Biomedical

(Continued) 5Muradet

al./Resea

rchin

Socia

landAdministra

tivePharm

acyj

(2013)1–20

Table 1 (Continued )

Author/year

reference No.


Patient-centered

communication

Interaction Process

Analysis (Roter52)

pharmacists asked more

questions (mainly closed

ones), while patients gave

more information.

Deschamps, Dyck,

and Taylor31To describe content and

organization of patient

counselling.

Controlled university lab

setting, Canada. Video

recording of standardized


interactions.

20 transcripts were

quantitatively coded

(scheme adapted from

recognized medicine

counseling guidelines).

Pharmacist provided: side

effect information (100%),

indication (100%), name of

medicine (95%), and

scheduling (95%). average

duration ¼ 3:20 min.

Pharmacist asked an

average of 8 � 4 close-

ended and 1 � 1 open-

ended questions.

Biomedical

Evans and John18 To compare and contrast

pharmacist medicine

counseling in UK and

USA.

Community pharmacies, UK

&USA. Audio recordings


interactions.

123 (63 from UK and 60 from

US) transcripts were


Pharmacists asked two

questions per interaction

and 95% were closed-

ended. Mean counseling

was 123 s in US and 69 in

UK. Pharmacists provide

11.2 information items per

interaction in US and 6.5

items in UK.

Biomedical

Evans et al39 To identify if clients can recall

information offered by

pharmacists.


Audio recordings of


interactions and patients

interviews.

98 transcripts of audio

recordings and phone

interviews were analyzed

quantitatively.

Only 24% of information

offered by pharmacists was

later recalled by patients.

Patients were more likely to

recall procedural advice

and repeated information.

Biomedical

Flynn et al32 To evaluate the dispensing

accuracy and counseling

provided.


USA. Video recordings of


interactions.



Of 100 prescriptions

dispensed, 22% had

dispensing error rate. A

total of 43 shoppers (43%)

received verbal counseling,

including 16 cases in which

the shopper prompted

counseling.

N/A

6Muradet

al./Resea

rchin

Socia

landAdministra

tivePharm

acy

j(2013)1–20

Greenhill et al62 To determine applicability of

Calgary-Cambridge guide

to pharmacy consults.


hospital and GP clinic,

UK. Audio recorded of


consults.


quantitatively using

Calgary-Cambridge guide.

Calgary-Cambridge guide can

be applied with minor

alterations to opening,

agenda setting, question

responses, and social talk.

Pharmacists may require

training on patient centered

skills.

Biomedical

Greenwood, Howe,

and Holland36To assess patient centeredness

and content of the consult

using validated tools.

Patients’ home, UK. Audio

recordings of patient–

pharmacist interactions.


quantitatively: Henbest and

Stewart Rating (assess

patient centeredness) and

SEGUE scale. (Set the

stage, Elicit information,

Give information,

Understand the patient’s

perspective, and End the

encounter, a checklist of

medical communication

tasks)

Scores were comparable to

physicians in that they

demonstrated high patient-

centeredness, and covered

all appropriate areas. Both

scales are suitable for

pharmacist patient

interactions.

Patient-Centered

Livingstone19 To examine the nature of

verbal interactions between

elderly people and

pharmacists.


Audio recordings of

interactions between

elderly patients and

pharmacists.


quantitatively.

Pharmacists provided

medicine information to

12.5% of elderly patients

that focused on aspects of

the dosage regimen. Mean

interaction was 71 s.

Biomedical

McMillan, Cameron,

& Power37To develop and test an

evaluation tool for GP and

pharmacist consults with

patients.

Video recordings of GPs and

pharmacists consult with

patients. Scotland.

18 GPS and 12 pharmacists’

video recordings were


Pharmacist tool omitted 2

examination questions.

Tool could discriminate

between GP but not

pharmacist performance

level.

N/A

Paluck42 To determine predictors of

the quality of patient–

pharmacist

communication.


Canada. Audio recordings


interactions.

765 interactions were

quantitatively analyzed

with a novel scale

Four of the variables

predicted communication

quality (pharmacists’

attitude, year of

graduation, adherence

expectations, and outcome

expectations).

N/A

(Continued)

7Muradet

al./Resea

rchin

Socia

landAdministra

tivePharm

acyj

(2013)1–20


Author/year

reference No.


Patient-centered

communication

Sigrist et al43 To evaluate an intervention

to improve patient

interactions about non-

prescription analgesics.


Switzerland. Audio

recordings of pseudo-

patient-pharmacy staff.

Staff training

workshop ¼ 15 h

14 Intervention pharmacies

with 98 consults; 14 control

pharmacies with 91

consults. Novel

quantitative scoring.

The intervention improved

the content and quality of

the patient-pharmacist/staff

interactions. Interactions

for restricted medicines had

the greatest improvement.

Biomedical

Smith, Salkind

and Jally34To assess quality of primary

health care advice given by

pharmacists.


Audio recordings of


interactions.

50 audio recordings were

quantitatively analyzed

with a novel scale.

54% of consults achieved

satisfactory scores on 75%

of the nine characteristics

while 25% were

satisfactory on 2 or fewer

characteristics.

Biomedical

Smith33 To explore pharmacists

communication focus and

style relative to health

promotion.

Same as above. 711 transcripts were analyzed

quantitatively.

Pharmacists’ advice focused

on the products rather than

symptoms. Pharmacists

asked 3 questions focused

on symptoms (79% closed)

and promptly answered

patient questions (97%).

Biomedical

Smith35 To investigation the referral

patterns of pharmacists.

Same as above. 108 of 716 transcripts had

referrals and were analyzed

quantitatively.

Pharmacists’ referrals were

determined by the

symptoms presented. Most

common referrals were

conditional and direct to

GP.

Biomedical

Stewart et al38 To develop and validate tool

to assess the quality of

pharmacist prescriber’s

consults.


Video recordings of


interactions.



with a novel tool.

Pharmacists scored 3/5

overall on quality.

Generated evidence for

reliability and validity.

N/A

Werner and Benrimoj44 To determine whether audio

recordings can improve the

reliability of data recalled

by simulated patients.


Australia. Audio

recordings of simulated


consults.

1340 audio recordings were


using simulated patient

tool.

Approximately 10% of

interactions had

discrepancies resulting in a

10%–20% change in the

score from the manual data

(a significant change).

N/A

8Muradet

al./Resea

rchin

Socia

landAdministra

tivePharm

acy

j(2013)1–20

Wilsonet

al40

1.Toidentify

theinform

ation

andadvicegiven

by

pharm

acist

2.Totest

recallof

inform

ationgiven

bythe

pharm

acist.

Twocommunitypharm

acies,

UK.Audio

recordingsand

observationsofpatient–

pharm

acist

interactions.

Interviewswithpatients.

1.212audio

recordingswere

analyzedquantitatively.

2.49interviewswereanalyzed

quantitatively.

1.Themost

frequenttopics:

generalhealthtopics,

discussionofsymptoms

andtreatm

entand

discussingmattersnot

covered

duringGP

consultations.

2.47%

ofpatients

omitted

inform

ation.Allrecalled

inform

ationwascorrect.

Patients

whoparticipated

received

more

inform

ation.

Biomedical


paradigm,53 effective strategies for verifying under-standing,26 and the role of assistants.23 In all para-digms, six studies used theory explicitly to guide theexploration of patient–pharmacist communica-

tion.20,46–50 The quantitative studies focused onthe “what”, the qualitative studies explored newor specific roles, and the conversational analysis

focused on the “how” patients and pharmacistsinteract.

Design and methods

Researchers used video recordings in ninestudies31,32,37,38,41,48,50,54,55 and audio recordingsin the remaining 32 studies to collect patient–

pharmacist interactions. In the qualitative48 anddiscourse analysis research,26–28,55 videos weretranscribed for analysis; thus video did not appearto add to the analysis. In the quantitative studies,

three studies coded elements only available invideo,37,38,41 while two examined content.31,32

Simulated patients in university practice laborato-

ries or community pharmacies were employed infour articles. In seven articles audio recordingswere collected in hospitals,45,48,56,57 five in pa-

tients’ homes,36,45,49,50,53 and the remaining re-search studies were conducted in communitypharmacies. No clear pattern emerged between

research paradigm and research location. The dis-course research was most likely two have multipleanalyses conducted on one dataset (Table 3). Onedataset was used in both a quantitative31 and dis-

course analysis study.55 Ten studies combined twoor three data collections methods such as: ques-tionnaires, non-participant observations and in-

terviews. Multiple methods of data collectionwere most prevalent in the qualitative para-digm.25,46–48 We did not identify any longitudinal

studies. The single intervention study found thathealth belief model and use of open-ended ques-tions improved the content and quality of patient

interactions.43 The bulk of this research has beenconducted in the United Kingdom followed bythe United States of America.

Consent procedures were outlined in the ma-

jority of studies, but 10 out of 41 studies (i.e., 7datasets) did not report consent procedures orapproval from an ethics review commit-

tee.25,29,32,37,45,51,56–58 One study reported ethicalapproval, but not consent procedures.47 Nine ofthe studies posted a sign to inform the patients

of the recording, assuring them of anonymityand confidentiality with five studies using this asthe sole form of consent.29,34,35,40,54 Oral consent

Table 2

Qualitative studies

Author/year

reference No

Research questions Method Analysisa Main findings Biomedical/

patient-centered

communication

Babalola and Erhun48 To identify areas of

communication breakdown

caused by pharmacist.

University teaching hospital,

Nigeria. Audio, video

recordings of medicine

histories and questionnaire.

20 transcripts were qualitatively

coded and analyzed using the

socio-linguistic model.

Miscommunication occurred

because of a noisy

environment or the

pharmacist used technical

and vague statements, did

not integrate patient

perceptions, did not explain

intent, or gave conflicting

advice

Biomedical

Chen and Britten45 To investigate feasibility of

using primary care

pharmacists as medicine

counselors.

GP surgeries and patients’

homes, UK. Audio recording


interactions.


qualitatively.

The clinical pharmacists

experienced few problems

with the consults. Patients

were willing to discuss their

medicines in detail with

pharmacists.

Patient-centered

Leontowitsch et al46 To describe feasibility and

acceptability of concordance

in pharmacy.


Audio recording of patient–

pharmacist consults.

Observations and interviews

with pharmacists and

patients.


qualitatively.

Pharmacists adapted their own

model of concordance (i.e.,

open-ended exploration to

understand and incorporate

the patient perspective into

treatment discussions).

Customers reported a high

level of satisfaction.

Patient-centered

Montogomery et al25 To describe the characteristics

and content of pharmacists

providing pharmaceutical

care.


Sweden. Audio recordings of


interactions. Non-participant

observations.

16 transcripts with five

pharmacists were analyzed

qualitatively using

interpretive approach.

Counseling behaviour was

characterized by variable

listening, asking questions, a

willingness to help, use of

computers, and identification

of patient needs.

Patient-centered

Stevenson,

Leontowitsch,

and Duggan47

To explore how pharmacists

maintain their professional

expertise

Same as Leontowitsch 2005

above.


qualitatively.

Engaging patients did not

reduce the pharmacist

expertise. Patient desired

differing levels of

engagement/expertise.

Biomedical

a Unless noted, qualitative studies use thematic analysis approach.

10

Muradet

al./Resea

rchin

Socia

landAdministra

tivePharm

acy

j(2013)1–20

Table 3

Discourse analysis studies

Author/year

reference No


patient-centered

communication

Salter et al49 To what extent the advice

given by pharmacists is

acknowledged and accepted

by patients.

Participants’ home, UK.

Patient–pharmacist

medicine reviews were

observed and recorded.

Pharmacist and patient

interviews.


by discourse analysis.

Pharmacists usually offered

advice and information in a

didactic manner despite

patient displays of

competence. Advice was

often resisted/rejected by

patients.

Biomedical

Dyck, Dechamps,

and Taylor55To determine number of

adverse effects mentioned

and how pharmacists

articulated likelihood

occurrence.

Controlled university lab

setting, Canada. Video

recording of standardised


interactions.


by conversation analysis.

Pharmacists discussed side

effects and management

strategies with an average of

4 � 2 unique side effects.

Vague, verbal descriptors of

frequency were used.

Biomedical

Garner and Watson59 To study consults between

medicines counters

assistants (MCA) and

customers for non-

prescription medicine.


Scotland. Audio recordings

of MCA-patient counseling.


by discourse analysis.

Of 773 utterances, 61% were

information eliciting, 13%

information giving, 14%

advice giving and 11%

other. Most frequently

asked who is taking the

medicine and other current

medications.

Biomedical

Nguyen50 To examine multiparty conflict

talk in a pharmacy consults.

Community pharmacies, USA.

Video recordings of patient–


1 transcript was analyzed with

in-depth conversational

analysis.

Conflict gradually occurred

with indirect and reluctant

communication. It was

resolved with appeals to an

outside third party

(physician) and delicate

alignment.

N/A

Pilnick51 To determine the influence of

patient expertise on the


interaction.

Pediatric outpatient oncology

clinic, UK. Audio-recording

of patient/carer–pharmacist

interactions.


using conversation analysis/

ethnography.

Patient expertise reduces the

expected interactional

dominance of the

pharmacist. Patient and

pharmacist dominance

varies within an interaction.

Biomedical

(Continued)

11

Muradet

al./Resea

rchin

Socia

landAdministra

tivePharm

acyj

(2013)1–20


Author/year

reference No


patient-centered

communication

Pilnick57 To characterize patient–

pharmacist counseling as

instructing, advising or

giving information.

Same as above. 45 transcripts were ana ed

using conversation an ysis.

Pharmacists instruct patients

on medicine use rather than

providing general

information or personalized

advice.

Biomedical

Pilnick56 To describe the structures of


interaction.

Same as above. Same as above. Structure: Opening/greeting,

approach and arrival at

advice giving, acceptance/

rejection, delivery and

response to information

(assuming patient is not

knowledgeable), close and

exit.

Biomedical

Pilnick, A.58 To examine how pharmacists

initiate advice giving.

Same as above. Same as above. 4 approaches to advice giving:

patient request, pharmacist

gives information

immediately, pharmacist

offers or states intention,

and step-wise approach to

evaluate the situation first

Biomedical

Salter53 To examine the influence of the

compliance paradigm on

medicine review.

Patient homes, UK. Audio



Non-participant

observation.

29 transcriptions were

analyzed using discou e

analysis.

Pharmacist led structures

interactions which explore

patients’ ability to comply

with medicines. Patients

resisted inquiries that

threatened their

competence.

Biomedical

Watermeyer27 To describe how pharmacists

talk about antiretrovirals

(ARVs) with patients.

Pharmacy in a public ARV

Clinic, South Africa.Video

recording of patient–


26 transcripts were ana ed

by conversation anal s.

Pharmacists discussed ARVs

in three contexts: ARV for

the rest of patient’s life, to

save patient’s life and to feel

better.

Patient-centered

12

Muradet

al./Resea

rchin

Socia

landAdministra

tivePharm

acy

j(2013)1–20

lyz

al

rs

lyz

ysi

Watermeyer

and Penn26To identify the effective

strategies for verifying

patient understanding of

ARV dosage instruction.

Same as above. Same as above. Strategies to verify patient

understanding include

asking for patient

demonstration, using

specific questions, asking if

information was

understood, and monitoring

patients’ verbal and non-

verbal responses.

Patient-centered

Watermeyer

and Penn28To examine the structure of


interactions.

Same as above. Same as above. Patient–pharmacist

interactions had a clear

structure that contained

multiple cycles of delivery of

instruction, patient

response, and verification of

understanding.

Patient-centered

Ylanne and John23 To describe the role of

medicine counter assistants

(MCA) when dealing with

patients.


Audio recordings of patient-

MCA/pharmacists

interactions.

29 transcripts were ana zed

using discourse analy s.

MCA are involved in three

ways: dealing solely with the

patient, checking advice

with the pharmacist while

dealing with the patient, and

keeping the patient ‘on hold’

until the pharmacist is ready

for counseling.

N/A

13

Muradet

al./Resea

rchin

Socia

landAdministra

tivePharm

acyj

(2013)1–20

ly

si

Table 4

Studies employing other methods

Author/year reference No Research questions Method Analysis Main findings Biomedical/

patient-centered

communication

Bissell, Ward, and Noyce60 To identify the criteria to

assess appropriateness of

common ailments

management.


UK. Audio recordings of


interactions. Non-

participant observation.

10 of 624 transcripts were

used to assess the

feasibility of a set of

expert criteria.

Audio recordings provided

the context for a

stakeholder process on

the development of

guidelines for

appropriateness.

N/A

Hargie, O. D. W., Morrow,

N. C., & Woodman, C.54To identify what constituted

effective communicative

performance by

pharmacists.


UK. Video recordings of


interactions.


analyzed qualitatively by

pharmacists, and

quantitatively by

researchers.

Eleven communication

categories were identified

and ranked: building

rapport, explaining,

questioning, listening,

non-verbal, advising,

opening, closing,

assertiveness, disclosing

personal information,

and persuading. Effective

consults were more likely

to use patient centered

skills.

Patient-centered

Skoglund, Isacsan, and

Kjellgren61To explore the patient–

pharmacist

communication when

dispensing prescription

analgesics.


Sweden. Audio



42 audio recordings and

transcripts were analyzed

qualitatively and

quantitatively with a

focus on structure,

content, and interaction.

Patients had a passive role

and asked three

questions. Pharmacists

asked an average of 4.6

questions and 2% were

open-ended. Pharmacists

dominated the

interaction.

Biomedical

14

Muradet

al./Resea

rchin

Socia

landAdministra

tivePharm

acy

j(2013)1–20


was solely obtained in three studies,30,42,46 andoral consent was combined with a sign in onestudy.59 The remaining studies used a written con-sent in combination with oral consent and signs.

Data analysis

Quantitative methods dominated (Table 1)

followed by discourse analysis (Table 3). Only 3studies analyzed their data by other methods.54,60,61

All studies in the discourse analysis and qualitativeparadigmsanalyzed transcriptswhereas 10quantita-

tive studies (Table 1) conducted their analysis on theaudio itself by characterizing the content32,40 or byemploying a scoring tool.17,34,37,38,41–44 Studies using

a quantitative paradigm quantified the frequency ofencounter reason, content of oral drug information,oral drug information received, and pharmacists’

and patients’ behavior at the counter. Furthermore,the number, type, and content of questions asked bypharmacists were reported. Validated tools were

used toanalyze data in several studies,30,31,36,62 whilefive authors developed their own coding tools. Allstudies characterized elements of pharmacist com-munication, several also explicitly analyzed patients’

contribution to the interaction30,45–47,49,51,53 and twostudies examined patient recall.39,40

Main findings

Main findings were driven by the questionsasked in each research paradigm. The quantitativestudies characterized what happened between

patients and pharmacists. Pharmacists’ consulta-tion focuses mainly on medications instruc-tion.17,19,31,33,40 Several studies quantified the

number and type of questions asked by pharma-cists and found that pharmacists asked moreclosed questions than open ones.18,30,31 A compar-

ison showed that pharmacists provided more in-formation and advice than technicians.17,29 Inaddition, the percentage of what the patients re-

called after counseling was calculated and foundto be approximately a quarter of what the phar-macists said in one study39 and half in the secondstudy.40 Patients mainly recalled instructions and

repeated information.39,40 Quantitative methodol-ogy was used to develop and test evaluation toolsfor pharmacists consultations with patients37,38

and to measure patient-centeredness.36 Betterpharmacist communication quality and greaterpatient satisfaction resulted when patient-

centered skills were applied during counseling.41,42

The qualitative paradigm provided rich descrip-tions of novel pharmacists’ practice or areas.

Specialized pharmacists’ communication includedpatient engagement and acceptance.25,45,46 Pharma-cists’ expertise was important and not diminished byengaging patients in decision-making.47 Breakdown

in patient–pharmacist communication was due tothe pharmacist or pharmacy environment.48

Discourse analysis reported how pharmacists

communicate with patients. The structure of theinteraction was primarily focused on the pharma-cist providing medication information. Patients’

expertise was disregarded by pharmacists,49 re-duced pharmacists’ expected dominance,51 andled to patients disregarding advice49 or inquires

that threatened their competence.53 Pilnick foundthat conflict was resolved with referrals to physi-cians. Watermeyer and Penn identified four waysto verify patient understanding (Table 3).26

Ylanne and John described three ways pharmacistassistants interact with patients (Table 3).23

Several studies investigated the characteristics

of pharmacists and/or patients that may influencethe nature or extent of communication. Pilnickfound that patient expertise reduces the expected

interactional dominance of the pharmacist.51 Thequality of patient–pharmacist communication wasaffected by the environment and positively im-

proved if pharmacists applied patient-centeredskills18,41,42,48,54 such as: patient involvement, lis-tening, and integrating patients perception.

Presence of patient-centered vs. biomedicalcommunication

The research paradigm with its resulting ques-tion and measurement model had an impact on

whether or not patient-centered or biomedicalcommunication was characterized. Eight studiesfound evidence of a patient-centered model in

patient–pharmacist interaction, whereas 23patient–pharmacist interactions exhibited a bio-medical focus. Patient-centered communication

primarily took place in specialty clinics and bypharmacists with additional training or a specificclinical focus.25–28,36,45,46 The community-basedpharmacy study that identified patient-centered

behaviors used pharmacists to characterize effec-tive communication performances.54

Quantitative studies focused on the clinical

content resulting in a focus on biomedical com-munication. If patient-centered communicationwas present it was not quantified with the excep-

tion of Greenwood, Howe, and Holland36 whoused validated scales with the specific intent ofcharacterizing patient-centered communication.


Qualitative research, which studied specializedpharmacists, found patient-centered communica-tion.25,45,46 Other topic questions on communica-

tion breakdown48 and pharmacists expertise47 ledto a focus on biomedical communication. Dis-course analysis described eight studies with abiomedical and three with patient-centered

communication style. The patient-centered com-munication style was found in a specialty clinicand these studies described how pharmacists

counsel patients about their antiretroviral medi-cations.26–28

Discussion

Forty-one studies were identified that analyzedvideo and audio recordings of patient–pharmacistinteractions. A greater number of articles were

found than were identified in prior reviews4,16 be-cause additional keywords were included such asdiscourse, conversation, narrative, and content

analysis and the search was conducted in both so-ciological and health sciences literature databases.Research on recordings of patient–pharmacist in-

teractions reside within multiple research fieldswith distinct traditions within pharmacy as wellas sociology and linguistics.

The majority of studies were published in thelast ten years, suggesting a growing interest inpatient–pharmacist communication. The vast ma-jority of the research was conducted using audio

recordings in community pharmacies and wasdescriptive in nature. Consent procedure wasdescribed in the majority of studies with a majority

using written consent. The five studies that useda pharmacy sign as the sole means to alert patientsoccurred in 2000 and earlier. Few studies used

simulated patients during data collection. Onlythree of the 10 studies that employed videosanalysed non-verbal behavior. Transcripts of

recorded patient–pharmacist interactions wereused in the analysis process in both qualitativeand discourse methodologies. Half of the quanti-tative studies analyzed the transcripts and the

remaining quantified the content directly from therecording with scoring tools. In most of thestudies, results were analyzed quantitatively while

discourse analysis and qualitative methods wereemployed in the remaining articles.

Much of the literature covered in this review

suggests, (1) that the evidence of biomedical vs.patient-centered models in the studies’ findingsdepends on the research questions and analysis

methods; (2) the majority of studies using a bio-medical approach looked at the content of patientcounseling and quantified their findings; (3) eight

studies found pharmacists applied several ele-ments of patient-centeredness during theirconsultations with patients. These results alsoresonate with the views of several papers that

recognize the need for closer attention to patient-centered care in current-day pharmacy.15,63–65

One of the included studies showed that patients

reported a high level of satisfaction when thepharmacists adapted their own model of concor-dance.46 However, the results also conflict with

the previous finding in the medical literature thatwhile the vast majority of patients prefer thepatient-centered approach, a significant propor-tion still prefers a biomedical communication

model.66 No single demographic or clinical char-acteristic reliably predicts patients’ communica-tion style preferences,66,67 and prior research

shows that pharmacists are often unaware ofwhat patients expect and evaluate as being impor-tant when they visit the pharmacy.68,69 Krass et al

have shown that pharmacists’ use of one well-intended question may trigger different patient re-sponses.70 Patients’ variation in responses may be

due to of their personal interpretation of the sug-gested relationship70 or health beliefs.71

Furthermore, the findings of this review showthat patient–pharmacist interactions are not con-

sistently analyzed as a dyad. Since patients andpharmacists individually determine the quality oftheir interactions, it is important to incorporate

both parties’ prior experiences.3 A very limitednumber of studies in this review described howthe quality of patient–pharmacist interactions is

positively affected with pharmacists’ centeredcare skills. This review described the studies thatanalyze recorded patent–pharmacist interactionand it shows that audio and video recording meth-

odology allows researchers to draw conclusionsabout the real-time effects of interaction betweenpatients and pharmacists.20 However, recordings

can create an artificial environment, as pharmacistand patient are aware that they are being recordeddue to the consent procedures. This causes a be-

havioral change, the so-called ‘Hawthorne effect’.Some studies recorded patient–pharmacist inter-actions in the absence of a researcher in order to

decrease the ‘Hawthorne effect’.25,29,53,60

Few studies used simulated patients in theirresearch.We identified only three data sets and fourstudies that used simulated patients. Two used real

pharmacists in a lab where the pharmacist was


aware of the interaction31,55 and twowere recordedin the community pharmacy setting where pharma-cists were unaware of simulated patients but wereinformed that a visit would come within a desig-

nated timeframe.43,44 Using simulated patientscan enhance the reliability and validity of thedata22 and allow for comparisons between pharma-

cist responses to the same patient query. Simulatedpatients can judge the performance of the pharma-cist in a reliable way. Finally, the simulated patient

has increased face validity if the pharmacist doesnot know or suspect the presence of a simulatedpatient.

Few studies used more than one method ofdata collection but two studies used both quanti-tative and qualitative analysis methods. Mixedmethods data collection and analysis may provide

more thorough and insightful findings.72 Severalstudies employed qualitative methods of data col-lection (e.g., interviews) and also presented quali-

tative data (such as verbal data rather thatnumerical data). Using qualitative methods inpharmacy communication research is important

for understanding social situations from the view-point of all parties involved. Non-specific the-matic analysis was the predominant analysis

approach. One study used an interpretive ap-proach whereby the researchers developed a senseof the whole dataset before generating impres-sions of the individual parts.

In several studies data was analyzed usingdiscourse analysis. In these studies, this methodis described as qualitative. However, discourse

analysis can be both a quantitative and qualitativemethod.73 Discourse analysis resulted in rich de-scriptions of patient–pharmacist interactions and

contributed to new understandings of how pa-tients and pharmacists manage conflict, power,and expertise when communicating about medica-tion. The questions and thick analysis resulting

from discourse analysis may not directly lendthemselves to practice enhancements, but mayguide the understanding of existing communica-

tion practices.

Strengths and limitations

Possible limitations include not searching fordissertations or unpublished work and the re-striction to only English language articles. The

data is widely varied and not sufficiently mature toallow for definite conclusions. There are severalpoints of strength in our review. It is based on

a literature search conducted in several databasesin both the health and social sciences. A detaileddescription of research questions, methods, anal-yses and findings is presented. This is the first

review to discuss this number of studies thatcollected and analyzed audio and video recordingsof patient–pharmacist interactions.

Future research directions

The diversity of this body of research could

lead in many directions. First, researchers shouldcarefully match the research objective, method ofrecording, and research methodology. There are

few pharmacy specific validated coding tools thatwould help quantify pharmacists’ and patients’communication. Simulated recall of information

presented in patient–pharmacist interactions mayprovide rigorous evaluation of patients and phar-macists’ perceptions of biomedical vs. patient-

centered communication. Future research usingdiscourse analysis may consider investigating thestructure of exchange between the patient–phar-macist dyad as well as characterizing structural

differences in communication in differing contexts(e.g., new vs. refill prescriptions). It would behelpful for the profession, patients, and re-

searchers to understand how pharmacists andpatients organized the interviews and how thismay have influenced patients’ medication taking

behaviors. It is not known how pharmacistsdetermine patients’ communication preferencesand subsequently adjusts their communication

styles according to patient preference. As thestructure of patient–pharmacist interactions isuncovered, it will be important to link pharma-cists’ communication to patient health outcomes.

Conclusion

There is a developing body of research usingaudio and video recordings to describe the contentof pharmacists’ communication in addition toexploring the quality of the interactions, valida-

tion of coding tools, the impact of an intervention,and an enhanced understanding of the patient–pharmacist power asymmetry. Evidence for bio-

medical vs. patient-centered models in the studies’findings depends on the nature of the researchquestions and analysis methods. The quantitative

studies focused on the “what”, the qualitativestudies explored new or specific roles, and thediscourse analysis focused on the “how” patients


and pharmacists interact. Future research shouldfocus on how pharmacists partner with patients toapply patient-centered care in differing contexts

and explore the links between communication andpatient health outcomes.

References

1. Kimberlin CL, Jamison AN, Linden S,

Winterstein AG. Patient counseling practices in

U.S. pharmacies: effects of having pharmacists

hand the medication to the patient and state re-

gulations on pharmacist counseling. J Am Pharm

Assoc 2011;51:527–534.

2. Babinec PM,RockMJ, Lorenzetti DL, Johnson JA.

Do researchers use pharmacists’ communication as

an outcome measure? A scoping review of pharma-

cist involvement in diabetes care. Int J Pharm Pract

2010;18:183–189.

3. Shah B, Chewning BA. Conceptualizing and mea-

suring pharmacist–patient communication: a review

of published studies. Res Social Adm Pharm 2006;2:

153–185.

4. Chewning BA. Patient involvement in pharmaceuti-

cal care: conceptual framework. Am J Pharm Educ

1997;61:394–401.

5. Swenson SL, Zettler P, Lo B. ‘She gave it her best

shot right away’: patient experiences of biomedical

and patient-centered communication. Patient Educ

Couns 2006;61:200–211.

6. Chewning BA, Sleath BL. Medication decision-

making and management: a client-centered model.

Soc Sci Med 1996;42:389–398.

7. Shoemaker SJ, Ramalho de Oliveira D, Alves M,

Ekstrand M. The medication experience: prelimi-

nary evidence of its value for patient education

and counseling on chronic medications. Patient

Educ Couns 2011;83:443–450.

8. Ramalho de Oliveira D, Brummel AR, Miller DB.

Medication therapy management: 10 years of expe-

rience in a large integrated health care system.

J Manag Care Pharm 2010;16:185–189.

9. Williams S, Weinman J, Dale J. Doctor–patient

communication and patient satisfaction: a review.

Fam Pract 1998;15:480–492.

10. Safran DG, Taira DA, Rogers WH, Kosinski M,

Ware JE, Tarlov AR. Linking primary care perfor-

mance to outcomes of care. Fam Pract 1998;47:

213–220.

11. Stewart MA. Effective physician–patient communi-

cation and health outcomes: a review. Can Med

Assoc J 1995;152:1423–1433.

12. Rao JK, Weinberger M, Kroenke K. Visit-spe-

cific expectations and patient-centered outcomes:

a literature review. Arch Fam Med 2000;9:1148–

1155.

13. Kaplan SH,Greenfield S,Ware JE. Assessing the ef-

fects of physician–patient interactions on the

outcomes of chronic disease. Med Care 1989;27:

110–127.

14. Levinson W, Roter DL, Mullooly JP, Dull VT,

Frankel RM. Physician–patient communication.

The relationship withmalpractice claims among pri-

mary care physicians and surgeons. JAmMedAssoc

1997;277:553–559.

15. Berger BA. Patient-centered care: it’s about time.

Am J Pharm Educ 2009;73:91.

16. Puspitasari HP, Aslani P, Krass I. A review of coun-

seling practices on prescription medicines in com-

munity pharmacies. Res Social Adm Pharm 2009;

5:197–210.

17. Blom L, Jonkers R, Kok G, Bakker A. Patient edu-

cation in 20 Dutch community pharmacies: analysis

of audiotaped patient contacts. Int J Pharm Pract

1998;6:72–76.

18. EvansWS, JohnDN.A preliminary investigation of

the interaction between UK and US community

pharmacists and their prescription clients. Int J

Pharm Pract 1995;3:157–162.

19. Livingstone C. Verbal interactions between elderly

people and community pharmacists about prescrip-

tion medicines. Int J Pharm Pract 1996;4:12–18.

20. Pilnick A. Advice giving in community pharmacies:

a response concerning methods for future research.

J Health Serv Res Policy 1998;3:97–99.

21. Stone AA, Tukkan JS, Bachrach CA, Jobe JB,

Kutzman HS, Cain VS, eds. The Science of Self-

report: Implications for Research and Practice. Mah-

wah, NJ: Lawrence Erlbaum Associates; 2000.

22. Mesquita AR, Lyra DP Jr, Brito GC, Balisa-

Rocha BJ, Aguiar PM, de Almeida Neto AC.

Developing communication skills in pharmacy:

a systematic review of the use of simulated

patient methods. Patient Educ Couns 2010;78:

143–148.

23. Ylanne V, John DN. Roles of medicines counter as-

sistants in advice giving in community pharmacies:

a discourse analysis. Pharm World Sci 2008;30:

199–207.

24. Wong G, Greenhalgh T, Westhorp G,

Buckingham J, Pawson R. RAMESES publication

standards: meta-narrative reviews. BMC Med

2013;11:20.

25. Montgomery AT, Kettis Lindblad A, Eddby P,

Soderlund E, Tully MP, Kalvemark Sporrong S.

Counselling behaviour and content in a pharmaceu-

tical care service in Swedish community pharmacies.

Pharm World Sci 2010;32:455–463.

26. Watermeyer J, Penn C. “Tell me so I know you un-

derstand”: pharmacists’ verification of patients’

comprehension of antiretroviral dosage instructions

in a cross-cultural context. Patient Educ Couns

2009;75:205–213.

27. Watermeyer J. “Now here come the pills that are go-

ing to save your life”: pharmacists’ discussions of

antiretroviral drugs in a context of life and death.

AIDS Care 2011;23:807–813.


28. Watermeyer J, Penn C. The organization of

pharmacist-patient interactions in an HIV/aids

clinic. J Pragmatics 2009;41:2053–2071.

29. Bissell P, Ward PR, Noyce PR. Variation within

community pharmacy. Part 1. responding to re-

quests for over-the-counter medicines. J Soc Adm

Pharm 1997;14:1–15.

30. Cavaco AM, Romano J. Exploring pharmacists’

communication with customers through screening

services. Patient Educ Couns 2010;80:377–383.

31. Deschamps M, Dyck A, Taylor J. What are we say-

ing? Content and organization of patient counseling

by community pharmacists. Can Pharm J 2003;136:

42–47.

32. Flynn EA, Barker KN, Berger BA, Lloyd KB,

Brackett PD. Dispensing errors and counseling

quality in 100 pharmacies. J Am Pharm Assoc

2009;49:171–180.

33. Smith F. Community pharmacists and health pro-

motion: a study of consultations between pharma-

cists and clients.Health Promot Int 1992;7:249–255.

34. Smith FJ, SalkindMR, Jolly BC. Community phar-

macy: a method of assessing quality of care. Soc Sci

Med 1990;31:603–607.

35. Smith FJ. Referral of clients by community phar-

macists in primary care consultations. Int J Pharm

Pract 1993;2:86–89.

36. GreenwoodK, HoweA, HollandR. The use of con-

sultation skills assessment tools in pharmacist–

patient consultations. Int J Pharm Pract 2006;14:

277–282.

37. McMillan R, Cameron N, Power A. Pilot study to

develop and test a generic peer feedback instrument

to review videotaped consultations in primary care.

Qual Prim Care 2011;19:347–354.

38. Stewart D, George J, Bond C, et al. Developing and

validating a tool for assessment of pharmacist pre-

scribers’ consultations. Fam Pract 2010;27:520–526.

39. Evans SW, John DN, Bloor MJ, Luscombe DK.

Use of non-prescription advice offered to the public

by community pharmacists. Int J PharmPract 1997;

5:16–25.

40. Wilson M, Robinson EJ, Ellis A, Blenkinsopp A,

Panton R. Studying communication between com-

munity pharmacists and their customers. Pharm J

1989;243(Suppl):R45.

41. Bentley JP, Stroup LJ, Wilkin NE, Bouldin AS. Pa-

tient evaluations of pharmacist performance with

variations in attire and communication levels.

J Am Pharm Assoc 2005;45:600–607.

42. Paluck EC, Green LW, Frankish CJ, Fielding DW,

Haverkamp B. Assessment of communication bar-

riers in community pharmacies. Eval Health Prof

2003;26:380–403.

43. Sigrist T, Benrimoj SI, Hersberger K, Langford J.

Changing pharmacists’ and pharmacist assistants’

practice in dealing with direct requests for non-

prescription analgesics. Int J Pharm Pract 2002;10:

23–29.

44. Werner JB, Benrimoj SI. Audio taping simulated

patient encounters in community pharmacy to en-

hance the reliability of assessments. Am J Pharm

Educ 2008;72:1–7.

45. Chen J, Britten N. ‘Strong medicine’: an analysis of

pharmacist consultations in primary care. Fam

Pract 2000;17:480–483.

46. Leontowitsch M, Stevenson F, Nazareth I,

Duggan C. ‘At the moment it is just a couple of ec-

centrics doing it’: concordance in day-to-day prac-

tice. Int J Pharm Pract 2005;13:273–280.

47. Stevenson FA, Leontowitsch M, Duggan C. Over-

the-counter medicines: professional expertise and

consumer discourses. Sociol Health Illn 2008;30:

913–928.

48. Babalola OO, Erhun WO. Pharmacist medication

history interview of elderly patients in a teaching

hospital in Nigeria. Int J Pharm Pract 2001;9:

97–103.

49. Salter C, Holland R, Harvey I, Henwood K.

“I haven’t even phoned my doctor yet”. The advice

giving role of the pharmacist during consultations

for medication review with patients aged 80 or

more: qualitative discourse analysis. Brit Med J

2007;334:1101–1104.

50. NguyenHT. Boundary and alignment in multiparty

conflict talk. J Pragmatics 2011;43:1755–1771.

51. Pilnick A. “Why didn’t you say just that?” Dealing

with issues of asymmetry, knowledge and compe-

tence in the pharmacist/client encounter. Sociol

Health Illn 1998;20:29–51.

52. Roter D, Hall JA. Doctors Talking with Patients/

Patients Talking with Doctors: Improving Com-

munication in Medical Visits. London: Praeger;

2006.

53. Salter C. Compliance and concordance during do-

miciliary medication review involving pharmacists

and older people. Sociol Health Illn 2010;32:

21–36.

54. Hargie OD, Morrow NC, Woodman C. Pharma-

cists’ evaluation of key communication skills in

practice. Patient Educ Couns 2000;39:61–70.

55. Dyck A, Deschamps M, Taylor J. Pharmacists’ dis-

cussions of medication side effects: a descriptive

study. Patient Educ Couns 2005;56:21–27.

56. Pilnick A. The interactional organization of phar-

macist consultations in a hospital setting: a putative

structure. J Pragmatics 2001;33:1927–1945.

57. Pilnick A. “Patient counseling” by pharmacists: ad-

vice, information, or instruction? Sociol Quart 1999;

40:613–622.

58. Pilnick A. "Patient counselling" by pharmacists:

four approaches to the delivery of counselling se-

quences and their interactional reception. Soc Sci

Med 2003;56:835–849.

59. GarnerM,WatsonMC. Using linguistic analysis to

explore medicine counter assistants’ communica-

tion during consultations for nonprescription med-

icines. Patient Educ Couns 2007;65:51–57.


60. Bissell P, Ward P, Noyce PR. Appropriateness

measurement: application to advice-giving in

community pharmacies. Soc Sci Med 2000;51:

343–359.

61. Skoglund P, Isacson D, Kjellgren KI. Analgesic

medication–communication at pharmacies. Patient

Educ Couns 2003;51:155–161.

62. Greenhill N, AndersonC, AveryA, PilnickA. Anal-

ysis of pharmacist–patient communication using the

Calgary-Cambridge guide. Patient Educ Couns

2011;83:423–431.

63. Rosenthal M, Austin Z, Tsuyuki RT. Are pharma-

cists the ultimate barrier to pharmacy practice

change? Can Pharm J 2010;143:37–42.

64. Rogers A, Hassell K, Noyce P, Harris J. Advice-

giving in community pharmacy: variations between

pharmacies in different locations. Health Place

1998;4:365–373.

65. Hassell K, Rogers A, Noyce P. Community phar-

macy as a primary health and self-care resource:

a framework for understanding pharmacy utiliza-

tion. Health Soc Care Comm 2000;8:40–49.

66. Swenson SL, Buell S, Zettler P, White M,

Ruston DC, Lo B. Patient-centered communica-

tion: do patients really prefer it? J Gen Int Med

2004;19:1069–1079.

67. Savage R, Armstrong D. Effect of a general

practitioner’s consulting style on patients’ satis-

faction: a controlled study. Brit Med J 1990;

301:968–970.

68. Assa-Eley M, Kimberlin CL. Using interpersonal

perception to characterize pharmacists’ and pa-

tients’ perception of pharmaceutical care. Health

Commun 2005;17:41–56.

69. Worley MM, Schommer JC, Brown LM, et al.

Pharmacists’ and patients’ roles in the pharmacist–

patient relationship: are pharmacists and patients

reading from the same script? Res Social Adm

Pharm 2007;3:47–69.

70. Kaae S, Traulsen JM, Nørgaard LS. Challenges to

counseling customers at the pharmacy counterdWhy

do they exist?Res Social AdmPharm 2011;8:253–257.

71. Partridge MR, Hill SR. Enhancing care for people

with asthma: the role of communication, education,

training and self-management. Eur Respir J 2000;

16:333–348.

72. Creswell JW, Plano Clark V, eds. Designing and

Conducting Mixed Methods Research. 2nd ed.

United States of America: SAGE Publication; 2011.

73. Lazaraton A. 2. Quantitative and qualitative ap-

proaches to discourse analysis. Annu Rev Appl Lin-

gui 2002;22:32–51.

a meta-narrative review of recorded patient–pharmacist interactions: exploring biomedical or...

Documents