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Case study: CBT-based techniques enhance consultation skills

Summary

This workstream aims to equip community pharmacists and other health professionals with the skills they need to help patients better understand, consider and take charge of their medication. We want to achieve more timely and effective patient consultations, improve patient outcomes and satisfaction with health services, and reduce medicines wastage.

Background issue

Enhancing the communication and consultation skills of pharmacists has long been identified as a priority. Pharmacists are funded to provide face-to-face consultations about medicines through the Medicines Use Review (MUR) and the New Medicine Schemes (NMS). However, the NMS has recently undergone a national evaluation. Whilst it was found to improve adherence and was also cost-effective, a secondary evaluation uncovered that the NMS did not significantly change patient beliefs about their medicines, suggesting there is scope for improvement.

Cognitive behaviour therapy (CBT) has a proven track record of improving patient outcomes in a wide range of specialisms; it is a talking intervention, proven to help treat a wide range of emotional and physical health conditions in adults, young people and children. CBT examines how we think about a situation (cognitive component) and how this affects the way we act (behaviour). In turn, our actions can affect how we think and feel.

By using additional tools and skills alongside the MUR/NMS service, we believe pharmacists can empower their patients to consider factors that influence the way they take their medicines. This involves identifying barriers to taking medication, mutual decision-making and generating options between pharmacist and patient and will ensure patients’ needs are more thoroughly considered and they receive a service more tailored to their personal needs and health beliefs.

AHSN response

We carried out a feasibility study to find out whether CBT-based techniques training – delivered through the PIPPCare programme – could be implemented in a short delivery time and would be appropriate and effective. Twenty pharmacists were trained by professional coaches over two separate days, three weeks apart. Feedback from the course showed that trainees found the sessions useful and appropriate and they felt confident to use the techniques in future clinical practice. Read the full feasibility report here.

Who is taking part?

Following the feasibility testing, we are rolling out the skills training to at least another 150 trainees throughout the Oxford AHSN region in 2016. Contact Lindsey Roberts (see below) if you are interested in taking part.

Outcomes

Pharmacists who participated in the feasibility study were very positive about the training. One of the most striking results was the difference in opinion between how applicable the CBT model could be in helping resolve difficulties in patient consultations between the start and end of the training sessions. At the beginning of training, trainees reported a lack of understanding of the model and rated it as ‘not applicable’ to supporting patient decision-making. By contrast, when asked the same question at the end of day two trainees reported the CBT model was ‘very applicable’ to supporting patient decision-making.

Quotes

Following the course, practitioners said they were clear about how they thought their clinical practice would change as a result of the training. Within two training days, attendees were able to demonstrate that they could incorporate psychological approaches into routine clinical consultations.

“Skills that will not only benefit our patients but will enrich and empower us in life – amazing. Thanks!”

“A customers’ asthma was not being controlled adequately and during the consultation [she] admitted to a recent episode of abuse by a close relative. I really feel that the CBT course helped me to help her admit and cope with this. It also reinforced my signposting resources and helped me personally by being available to support me during something I found quite difficult”

Contact

Dr Lindsey Roberts, Medicines Optimisation Network Manager, Oxford Academic Health Science Network, Magdalen Centre North, Robert Robinson Avenue
Oxford Science Park, OX4 4GA

lindsey.roberts@medopt.oxfordahsn.org

AHSN core objectives

A – Promote health equality and best practice

B – Speed up adoption of innovation into practice to improve clinical outcomes

C – Build a culture of partnership and collaboration

D – create wealth through co-development, testing, evaluation and early adoption and spread of new products and services

Clinical priority or enabling theme (NHS outcome framework domains)

2 – Enhancing quality of life for people with long term conditions

3 – Helping people recover from episodes of ill-health or following injury

4 – positive experience of treatment and care

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