218300 Role of patient-pharmacist communication regarding health disparities: Minority patient attitudes and perceptions in clinical settings

Wednesday, November 10, 2010 : 12:45 PM - 1:00 PM

Elvin Hernandez, DrPH, MPH, CHES , Department of Pharmacotherapy and Outcomes Science, Loma Linda University School of Pharmacy, Loma Linda, CA
Patient-provider communication represents an essential relationship that may foster collaboration between the health care professional and patient towards optimal health outcomes. Limited research has been conducted examining patient-pharmacist communication processes and how they influence patient health outcomes. The objective of this pilot study is to investigate communication processes between pharmacists and their patients. We wish to enhance our understanding of how those communication processes influence health outcomes and disparities among minority populations. We conducted the first phase of a two-phase mixed-method, cross-sectional study at two San Bernardino County healthcare facilities that serve individuals from diverse ethnic backgrounds. We recruited a total of seventy-six patients from an internal medicine in-patient hospital and an ambulatory care out-patient clinic. Patients who fulfilled the inclusion criteria were consented and completed a 1-sheet, 2-page anonymous survey containing sociodemographic variables to describe the patient population, interpersonal processes of care (IPC) measures of communication, and binary outcome measures for medication compliance. We conducted univariable and bivariable analyses consisting of independent samples t-tests and chi-square tests to explore continuous- and nominal-level variables, respectively. We performed multivariable analyses consisting of exploratory factor analysis with Varimax rotation, Cronbach alpha calculations, and logistic regression modeling. From the factor analysis, we extracted four factor items. Factor 1 represents interactive and informative pharmacotherapy counseling between pharmacist and patient (Cronbach alpha=0.906). Factor 2 represents positive, validating communication style regarding pharmacist interaction with patient (Cronbach alpha=0.910). Factor 3 represents perceptions of patient background regarding race, level of education, and income (Cronbach alpha=0.911). Factor 4 represents negative, disempowering communication style regarding pharmacist interaction with patient (Cronbach alpha=0.831). When regressing our binary outcome measures on these factors in a logistic regression analysis, our results indicate Factor 2 (OR: 2.951, 95% CI: 1.143-7.618, p=0.025) and Factor 3 (OR: 5.213, 95% CI: 1.724-15.759, p=0.003) were significantly associated with whether or not patients took any prescribed medications. Our results suggest that positive and validating communication processes between patient and pharmacist posed approximately three-fold odds of patients complying with their medications. Patients who did not experience pharmacists' perceptions of patient background regarding race, level of education, and income resulted in more than five-fold odds of medication compliance. Our results suggest that patient-pharmacist communication processes are important components in medication compliance, particularly when patients experience positive or negative interactions with pharmacists in clinical settings. Specifically, positive communication processes appear to improve medication compliance behaviors among this sample of diverse individuals.

Learning Areas:
Biostatistics, economics
Communication and informatics
Diversity and culture
Other professions or practice related to public health
Public health or related research
Social and behavioral sciences

Learning Objectives:
1. Identify barriers or enabling factors to communication between the pharmacist and patient that may be associated with the health disparities among minority patients in clinical settings. 2. Identify the attitudes and perceptions among minority patients towards the pharmacist’s role in managing the patient’s health and treatment regimens. 3. Describe levels of communication as measured by Interpersonal Processes of Care (IPC) among minority patients who participate in clinical health care activities with a pharmacist.

Keywords: Communication, Minority Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: As principal investigator for this research project, I received training in Health Education, Biostatistics, and the Social Behavioral sciences that was necessary to complete this research.
Any relevant financial relationships? Yes

Name of Organization Clinical/Research Area Type of relationship
New Investigators Program for Pharmacy at the American Association of Colleges of Pharmacy pharmacy Independent Contractor (contracted research and clinical trials)
American Foundation for Pharmaceutical Education pharmacy Independent Contractor (contracted research and clinical trials)

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.