Pharmacist–patient communication on use of antidepressants: A simulated patient study in community pharmacy

Abstract Background Effective communication between community pharmacists and patients, particularly with a patient-centered approach, is important to address patients' concerns relating to antidepressant medication use. However, few studies have investigated community pharmacists' communication behaviors in depression care. Objective To characterize community pharmacist–patient interactions during consultations involving use of antidepressants. Methods Twenty community pharmacists received 3 simulated patient visits involving issues related to the use of antidepressants: 1) patient receiving a first-time antidepressant prescription; 2) patient perceiving lack of efficacy of antidepressants after 2 weeks of treatment, and 3) patient intending to discontinue treatment prematurely. All 60 encounters were audio-recorded and analyzed using the Roter Interaction Analysis System (RIAS), a quantitative coding system that characterizes communication behaviors through discrete categories. A patient-centeredness score was calculated for each encounter. Results The majority of pharmacist communication was biomedical in nature (50.7%), and focused on providing therapeutic information and advice on the antidepressant regimen. In contrast, only 5.4% of pharmacist communication was related to lifestyle/psychosocial exchanges. There were also few instances of emotional rapport-building behaviors (8.6%) or information gathering (6.6%). Patient-centered scores were highest in the scenario involving a first-time antidepressant user, as compared to other scenarios involving issues with continued therapy. Conclusions Community pharmacists appeared to adopt a “medication-centered” approach when counseling on antidepressant issues. There is scope for improvement in patient-centered communication behaviors, particularly lifestyle/psychosocial discussions, facilitating patient participation, and emotional rapport-building. The RIAS appears suited to characterize brief consultations in community pharmacies and can provide a framework in guiding communication training efforts. Further research is needed to assess the impact of pharmacist communication behaviors on patient care outcomes.