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

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.