Patient-Centeredness In Pharmacist Practice: Filling A Foundation For What Counts To Patients

University of Minnesota Ph.D. dissertation. July 2020. Major: Social and Administrative Pharmacy. Advisor: Jon Schommer. 1 computer file (PDF); xv, 282 pages.Background: There is general agreement among nearly all healthcare stakeholders that team-based, ‘Patient-Centered Care’ (PCC) is essential to successful prevention and management of chronic disease as well as the promotion of health and well-being. However, there is ambiguity and divergent thinking about the explicit meaning of the ‘Patient-Centeredness’ (PC) theoretical construct that informs PCC. Contemporary PC research has focused on identifying the commonalities of PC conceptualizations across healthcare populations (e.g., age, disease), settings (e.g., outpatient, inpatient), and professions (e.g., Medicine, Nursing) to reflect the interprofessional and team-based nature of contemporary healthcare practice. The Joint Commission of Pharmacy Practitioners’ “Pharmacists’ Patient Care Process” (PPCP) places PCC at the center of its model but provides little detail about the meaning of PC. A well-articulated conceptualization of PC is a necessary precursor for ensuring fidelity in the measurement, practice, and evaluation of team-based PCC provided by pharmacists with patients. Objectives: This study aims to (1) uncover how PC is defined and conceptualized in care provided by pharmacists with patients and (2) describe, interpret, and compare patient preferences and expectations of PC in care provided by pharmacists with patients. Methods: This study used a qualitative directed content analysis design. Data were collected using semi-structured, in-depth interviews from a key-informant nominated sample of patients and pharmacists spread over nine U.S. states and three types of outpatient care settings. All pharmacist study participants (n=9) were actively providing care services and had a minimum of 10,000 hours of experience providing care consistent with the PPCP. Patient study participants (n=6) were receiving care from pharmacists enrolled in the study and had multiple chronic conditions. The trustworthiness of the qualitative data collected was assessed using methods outlined by Guba & Krefting. HASH(0x41e08f8) Results: For Objective 1, analysis of the data and review of the pharmacy and broader PC literature yielded the “Team-based Outpatient Pharmacist Practice for Patient-Centeredness” (TOPPP) model, consisting of 13 concepts and seven conceptual groupings. A comparison between data provided by pharmacists and patients also showed high levels of agreement about the relative importance of each respective PC concept, with some differences. For Objective 2, data analysis revealed three patient archetypes related to PC preferences and expectations: ‘Partner,’ ‘Client,’ and ‘Customer.’ Discussion/Conclusion: The study’s first overarching finding is that PC in pharmacist practice is (a) broader in scope, (b) more granular in specificity and, (c) more connected to other healthcare disciplines than currently conceptualized. The study’s second overarching finding is that PC in pharmacist practice is achievable across outpatient care contexts, especially with careful recognition of the preferences and expectations of the patients participating in and receiving care. The findings from this study open numerous avenues for hypothesis generation and future research into PCC provided by pharmacists with patients about best practices, professional training, measurement validation, system design, value-based payment assessments, and remediation of care barriers