PHAR 7733 Clinical Communications 7 November 2017

Interprofessional Collaboration & Electronic Communication Philip E. Looper, PharmD

Philip E. Looper, PharmD

College of Pharmacy RM 135C
T: 405-271-6878x47264
E: philip-looper@ouhsc.edu

INTERPROFESSIONAL COLLABORATION & ELECTRONIC COMMUNICATION

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Objectives
1. Define collaborative practice agreement (CPA)
2. Delineate between facilitators and barriers to CPAs
3. Identify strategies for CPAs
4. Given an example conversation, select the appropriate communication
model characteristic from the AIDET and/or I-SBAR communication methods
5. Evaluate the appropriateness of example emails based on professional email
etiquette
6. Recall guidelines for communicating through social media and other
electronic methods
7. Discern appropriateness of publicly shared personal information

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Lecture References
1. Interprofessional Collaboration and Effective Communication Skills. In:
Beardsley RS, Kimberlin CL, Tindall WN. Communication Skills in Pharmacy
Practice. 6th Edition. Lippincott Williams & Wilkins, 2012.
2. Cain JJ, Clauson KA, Fox BI. Electronic Communication in Health Care. In:
Beardsley RS, Kimberlin CL, Tindall WN. Communication Skills in Pharmacy
Practice. 6th Edition. Lippincott Williams & Wilkins, 2012.
3. Grindrod K, Forgione A, Tsuyuki RT, Giustini D. Pharmacy 2.0: A scoping
review of social media use in pharmacy. Res Social Adm Pharm 2014;10:256-
70.
4. National Center for Health Statistics. Health, United States, 2016: With
Chartbook on Long-term Trends in Health. Hyattsville, MD. 2017.
5. Centers for Disease Control and Prevention. Collaborative Practice
Agreements and Pharmacists Patient Care Services: A Resource for
Pharmacists. Atlanta, GA: US Dept. of Health and Human Services, Centers
for Disease Control and Prevention; 2013.
6. Giberson S, Yoder S, Lee MP. Improving Patient and Health System Outcomes
through Advanced Pharmacy Practice. A Report to the U.S. Surgeon General.
Office of the Chief Pharmacist. U.S. Public Health Service. Dec 2011.

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PHAR 7733 Clinical Communications 7 November 2017
Interprofessional Collaboration & Electronic Communication Philip E. Looper, PharmD

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INTERPROFESSIONAL COLLABORATION: THE COLLABORATIVE PRACTICE
AGREEMENT

I. Background & Importance

a. Overall healthcare costs: National health expenditures
i. 1960: $27.2 (billion)
ii. 2015: $3,205.6 (billion)

b. Prescription medication costs: National health expenditures

i. 1960: $2.7 (billion)
ii. 2015: $324.6 (billion)

II. Collaborative Practice Agreement (CPA)

a. Overview
i. Definition: a formal agreement in which a licensed provider
makes a diagnosis, supervises patient care, and refers
patients to a pharmacist under a protocol that allows the
pharmacist to perform specific patient care functions
ii. Example CPAs
1. Medication Therapy Management (MTM)
- medication therapy review, personal medication
record, medication-related action plan,
intervention and/or referral, and documentation
and follow-up
2. Collaborative Drug Therapy Management (CDTM)
- patient assessments, counseling, and referrals;
ordering laboratory tests; administering drugs;
and selecting, initiating, monitoring, continuing,
and adjusting drug regimens
3. Immunization Agreements
- Influenza, TDAP, etc
iii. Differ from state to state
1. Oklahoma Law
2. Other states

b. Benefits
i. Reduce ______________________ of care
ii. Lower health care costs
iii. Improve health outcomes
iv. Helps prevent errors
v. Improve medication adherence
vi. Shares responsibility of patient care team-based approach

c. Drawbacks
i. _______________________________

d. Facilitators
i. Shared discipline or practice area
ii. ___________________________
iii. Evidence of success for proposed CPA (e.g., pilot program,
research)
iv. Economic incentives

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PHAR 7733 Clinical Communications 7 November 2017
Interprofessional Collaboration & Electronic Communication Philip E. Looper, PharmD

e. Barriers
i. Unclear definitions / protocol language in CPA
ii. Lack of structural or institutional support
iii. Unfamiliarity with CPA from any/all healthcare providers
iv. Patient unfamiliarity with practices using CPAs
v. _____________________________________
vi. Lack of CPA-enabling technology (e.g., communication
technology)

f. Keys for Effective CPAs

i. Shared values (e.g., commitment to care)
ii. Partnership (e.g., 50-50 stake)
iii. Interdependency (e.g., CPA success depends on both party of
collaborators)
iv. Shared power (e.g., avoiding hierarchical structures (see
Interdependency above)

III. Policy Strategies for Expanding Pharmacists Patient Care Services Using
CPAs
a. Create and expand an infrastructure that embeds pharmacists
patient care services and collaborative practice agreements into
care, while creating ease of access for patients
b. Use simple, understandable, and empowering language when
referring to pharmacists patient care services
c. Allow the health care providers who enter into the CPA to define the
details of each agreement
d. Examine and redesign health professional scope of practice laws,
education curricula, and operational policies to create synergy,
promote collaboration, and make better use of support staff
e. Properly align incentives based on meaningful process and outcome
measures for patients, payers, providers, and health care systems
f. Provide incentives and support for the adoption of electronic health
records and the use of technology in pharmacists patient care
services
g. Maintain strong, trusting, and mutually beneficial relationships with
patients , doctors, and other providers and encourage those
individuals to promote pharmacists patient care services

IV. Characteristics of Effective CPA Models

a. _________________________________
i. Effective implementation of CPA
ii. Referrals for pharmacists patient care services
iii. Well-informed medical and pharmacy teams
iv. Meaningful communication between providers
b. _________________________________
i. Education on the potential for collaborative care with
pharmacists
ii. Use of every channel to distribute messages and generate
public support for pharmacists patient care services
iii. Expectation for collaboration on the health care team
c. _________________________________
i. Scalableimplementation and payment mechanisms that
work in different practice settings, creating market-driven care
delivery

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Interprofessional Collaboration & Electronic Communication Philip E. Looper, PharmD

ii. Sustainablepayers investing in the resources needed to

provide high-quality, integrated patient care
iii. Profitableproviders gaining the financial ability to focus on
providing prevention, patient health, and disease
management services while controlling health care costs

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COMMUNICATING WITH PATIENTS AND PRESCRIBERS

I. Build Rapport
a. Demonstrate competency
b. Strive to go above and beyond expectations
c. Provide good and consistent communication
d. Follow up and follow through as indicated
e. Persistence is the key
f. Document patient outcomes

II. Patient Communication Method: AIDET

a. AIDET
i. Acknowledge
1. Greet people. Look them in the eyes and smile. Use
names if you know them. The first delivered
impression is the most important and lasting
impression. Establish a preferred rapport with the
patient and patient family.
ii. Introduce
1. Introduce yourself politely. Tell the patient who you are
and how you are going to help. Explain your role,
function, experience, and skill set. Escort people
where they want to go, instead of pointing or giving
directions.
iii. Duration
1. Outline the actual expected duration and/or wait time.
Keep in touch regularly to ease the perception of
prolonged wait times. Let people know if there is a
delay, and provide realistic expectations of expected
wait times. Fix unnecessary wait times where
necessary.
iv. Explain
1. Tell the patient what to expect. Communicate any step
and address any question the patient may have. Make
time to help by recognizing and diminishing the
patients anxieties and uncertainties.
v. Thank
1. End the conversation with the patient by thanking
them for whatever theyre there for. Let them know
you appreciate them. Ask if there are any final
questions or concerns.
2. Example
a. Chick-fil-a _______________________

III. Communication with other Healthcare Providers

a. Important points

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PHAR 7733 Clinical Communications 7 November 2017
Interprofessional Collaboration & Electronic Communication Philip E. Looper, PharmD

i. Do not apologize for reaching out (i.e., have a good reason for
calling, faxing, etc)
ii. Keep it appropriate and patient-focused
iii. Be assertive, not aggressive
iv. Do not imply blame
b. Provider Communication Method: I-SBAR
i. Introduction who are you?
1. Hi ____, my name is Philip and I am calling from Phil's
Pharmacy.
ii. Situation what is the situation; why are you calling the
prescriber?
1. We have a patient here in the pharmacy who wants to
get an early refill on a control medication.
iii. Background what is the background information?
1. The patient picked up the same prescription almost a
month ago and we normally will do a maximum of two
days early on a control fill, but the patient is going out
of town today.
iv. Assessment what is your assessment of the problem?
1. The patient doesnt have a history of early refills and
its only a four days earlier than she normally receives
the medication
v. Recommendation how should the problem be corrected?
Offer possible solutions.
1. Since it is four days off, which isnt too far off from our
two-day policy, I do not mind going ahead and filling
this medication with your go ahead. We would fill the
next prescription based on the regular timeline.
c. What if the prescriber says no?
i. Remember: reasonable people can disagree about
pharmacotherapeutic choices
ii. Be polite
iii. Avoid right and wrong
iv. Keep communication channels open
v. Explain to patient in a way that doesnt undermine the
physician-patient relationship
IV. Other Communication Considerations
a. Document, Document, DOCUMENT
i. Name, Date, Time, Description of Changes/Modifications
ii. Written and/or electronic documentation
iii. Maintain records of all documents
b. Develop standard intervention forms (e.g., Prior Authorization (PA)
forms, medication change request forms, etc)

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ELECTRONIC COMMUNICATION

I. Guidelines for Electronic Communication

a. E-Professionalism
i. Definition: the attitudes and behaviors reflecting traditional
professionalism paradigms that are manifested through social
media
ii. Considerations for maintaining a professional online presence
1. Professionals are held to higher standards
2. Educate yourself on employer expectations

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Interprofessional Collaboration & Electronic Communication Philip E. Looper, PharmD

3. Do not post sensitive or proprietary information of your

employer
4. More than just your friends can view your
conversations
5. Conversations can easily be replicated and sent to
other people
6. Limit complaints to private, face-to-face conversations
7. Dont be labeled as a complainer, whiner, or as lacking
empathy
II. Email
a. Overview
i. Audience
1. Patients
2. Providers
ii. Content
1. HIPAA
2. Security
b. Etiquette
i. Proper grammar, syntax, punctuation (pharmaceutically
elegant emails?)
ii. Appropriately spell names of recipient(s) (hint: their name is
sometimes in their email address itself!)
iii. Do not email for highly sensitive matterscan set up other
meetings for those via email
iv. Respond to emails as quickly as you would like your emails to
be responded to
v. Do not reply all unless you are absolutely sure you should
vi. If you CC (Carbon Copy) someone, ensure they know why
vii. Use BCC (Blind Carbon Copy) to hide recipient email
addresses from other recipients (i.e., maintain privacy when
emailing customers about OTC sales in the pharmacy)
viii. Use Automatic Reply (e.g., Out-of-the-office message) and
offer alternative contact information for assistance
ix. Proofread

III. Social Media

a. Professional
i. Uses
1. Pharmacy Presence (e.g., Facebook page for
independent pharmacy)
2. Patient outreach (e.g., advertising, sales, community
service)
3. Professional Networking (e.g., LinkedIn)
4. Pharmacy-related blog, twitter account, Facebook page
(e.g., The Fit Pharmacist, Cynical Pharmacist)
ii. Considerations
1. Patient privacyHIPAA compliant use of social media
2. Securityensuring only appropriate staff have access
to social media accounts, appropriate antivirus
software installed
b. Considerations for Personal Use

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PHAR 7733 Clinical Communications 7 November 2017
Interprofessional Collaboration & Electronic Communication Philip E. Looper, PharmD

i. Do you use Facebook, Twitter, YouTube, LinkedIn, or Myspace

(really?)?
ii. Online presencewhat do others perceive/think of your
posts/comments?
iii. Have any patients sent you friend requests?
iv. Do you update colleagues on your professional experiences
via Twitter?
v. Do you follow pharmacy blogs or Facebook pages?
vi. Is your pharmacy using YouTube to post videos

c. Suggestions for Sharing

i. Use good judgment when posting information that may anger,
humiliate, offend, or mislead others
ii. Consider all potential members of the audience and how they
might react when you post to a social media site
iii. Avoid frequent whining and complaining posts
iv. Avoid posts that could depict you as a substance abuser
v. Consider how you will handle friend/follow requests from
patients and/or coworkers
vi. Do not violate patient privacy and confidentiality standards
vii. Use privacy features to control access to social media
information

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