Channel and Barriers to Effective Communication

Principles of team working

Good professional communication in health care is an essential component of team working. Many professionals, each with their own specific expertise, may be involved in the care of a single patient. This approach has the potential to deliver optimum care yet, to fully realise the health care benefits, the potential pitfalls must be recognised and ddressed.

Effective communication is central to achieving all of these components, whether it is at a superficial operational level as in the sharing of patient data, or at a deeper level focussed on an appreciation of another professional’s modus operandi and professional standing. Openness and honesty are paramount as well as effective team management, rather than leadership. Differing levels of remuneration of different team members may cause tensions within the team. These tensions are historical and will not be changed easily. Although resolution of such tensions and differential remuneration is the ultimate goal, in the interim it is important to make all team members feel equally valued in other ways.

Inter-professional communication

Of the health professionals interacting with community pharmacy, general medical practitioners are probably most involved with the pharmacist. The extended role features fairly regularly in journals read by the large majority of general medical practitioners. In general, such articles support a wider community pharmacy role, although there are those that express reservations. Surveys have also indicated that general medical practitioners are generally supportive of an extended role for the community pharmacist, although they tend to favour its more traditional, as opposed to its more innovative aspects. 

In one survey a mismatch was found as to why community pharmacists and general medical practitioners did not collaborate (Sutters and Nathan 1993). Seventy seven per cent of community pharmacists thought general medical practitioners did not want their input, but only 17% of the general medical practitioners admitted this. Thus, lack of confidence in the potential ‘professional welcome’ offered by the general medical practitioners could be a rate-limiting step to improved collaborative working practices.

The current position

A survey of London community pharmacists carried out in the late 1980s (Smith 1990), showed that 43% had some contact with primary health care personnel other than general medical practitioners. The most frequently cited professionals were the district nurse and staff of residential homes, although seventeen different professional groups were named, and the contacts were mostly initiated by the other profession, rather than the pharmacist.
The frequency of contact was at least weekly, though contact with general medical practitioners was more frequent. The vast majority of these contacts were associated with prescriptions, with three quarters of these contacts initiated by the pharmacist. The study gave an important insight into interaction with the primary health care team. Sixty per cent of the responding pharmacists felt that in spite of the level of contact, their contribution to the team was not acknowledged.

Some community pharmacists have a dispensing base within a health centre and it has been shown that these pharmacists have good communication with the local general medical practitioners. When the community pharmacists are based in health centres, there is more collaboration and communication between the two professions than when the pharmacist is more traditionally based in the ‘high street’. One of the medical participants in such a health centre commented that such pharmacists were ‘in a privileged position in that none of their advice need be commercially orientated’ (Harding and Taylor 1990).
Examples of good practice
Published work demonstrates an increasing number of examples of the community pharmacist being integrated into the health care team. For example, drug misuse is increasingly prevalent and the care of drug misusers has increasing resource implications. This problematic group of patients are not always welcomed by the professionals or their other clients, and their planned management is particularly important . In this regard, in Scotland in the 1990s two shared care schemes (between general practitioners and pharmacists) emerged independently (Gruer et al. 1997; Bond and Bunn 1998). 

In such schemes, general practitioners prescribe substitute methadone to drug misusers, following agreed principles of good prescribing but also including agreed communication with the pharmacist regarding the dispensing of the daily dose, encouraging professional feedback and making the drug misuser aware that this is all part of their formal programme of care. These schemes invoke a common purpose, acknowledge specific roles, and involve sharing of information and responsibility for outcomes. Similarly, on a more one to one basis, a clinical pharmacist working as part of a single practice team can run H. pylori eradication clinics and make recommendations for patient treatment (MacIntyre et al. 1997). 

These schemes demonstrate an understanding by the general practitioner of the pharmacist’s clinical knowledge, a trust that it will be used well, and a shared goal of reducing expenditure on drugs which could, in practice, be offset against the pharmacist’s salary. Finally, in this evidence-based age, community pharmacists, general practice colleagues and consultants have been brought together to develop clinical community pharmacy guidelines for use by pharmacists and their assistants when recommending OTC remedies. 

At the first of one of these group meetings which was formally observed using standard case study methodology, there was no mutual understanding across these three professional groups about their professional perspective, and for the doctors, of the knowledge base and skills of their pharmacy colleagues. After three or four meetings of open discussion and sharing of knowledge the situation was totally changed. At the end of the final meeting the consultant was reported as saying: ‘The community pharmacist is in a very useful position. I initially came to these meetings with a very negative attitude but now understand the role of the community pharmacist. These guidelines will be very important’ (Bond and Grimshaw 1995).


by Umaee
source: pharmacy practice
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