Seeing the Elephant: A Systematic Scoping Review and Comparison of Patient-Centeredness Conceptualizations from Three Seminal Perspectives.

"Patient-Centeredness" (PC) is a theoretical construct made up of a diverse constellation of distinct concepts, processes, practices, and outcomes that have been developed, arranged, and prioritized heterogeneously by different communities of professional healthcare practice, research, and policy. It is bound together by a common ethos that puts the holistic individual at the functional and symbolic center of their care, a quality deemed essential for chronic disease management and health promotion. Several important contributions to the PC research space have adeptly integrated seminal PC conceptualizations to improve conceptual clarity, measurement, implementation, and evaluation in research and practice. This systematic scoping review builds on that work, but with a purpose to explicitly identify, compare, and contrast the seminal PC conceptualizations arising from the different healthcare professional groups. The rationale for this work is that a deeper examination of the underlying development and corresponding assumptions from each respective conceptualization will lead to a more informed understanding of and meaningful contributions to PC research and practice, especially for healthcare professional groups newer to the topic area like pharmacy. The literature search identified four seminal conceptualizations from the healthcare professions of Medicine, Nursing, and Health Policy. A compositional comparison across the seminal conceptualizations revealed a shared ethos but also six distinguishing features: (1) organizational structure; (2) predominant level of care; (3) methodological approach; (4) care setting origin; (5) outcomes of interest; and (6) language. The findings illuminate PC's stable theoretical foundations and distinctive nuances needed to appropriately understand, apply, and evaluate the construct's operationalization in contemporary healthcare research and practice. These considerations hold important implications for future research into the fundamental aims of healthcare, how it should look when practiced, and what should reasonably be required of it.

Use of National Consumer Survey Data to Explore Perceptions of Complementary and Alternative Medicine.

BACKGROUND: Although Complementary and Alternative Medicine (CAM) has been the standard of therapy in Asia for centuries, it started receiving more attention in the U.S. in the last three decades. OBJECTIVES: The primary study objective was to explore individuals' perspectives of CAM. A secondary objective was to describe individuals' perceptions of pharmacists' roles in facilitating their use of these services and products. METHODS: Data were obtained from the 2015 and 2016 National Consumer Surveys on the Medication Experience and Pharmacist Roles. Data were collected from adults residing in the United States via on-line, self-administered surveys coordinated by Qualtrics Panels between April 28 and June 22, 2015 (n = 26,173) and between March 14 and 30, 2016 (n = 10,500). This study focused on written comments made in the surveys with Content Conventional Analysis applied to the text. Four researchers were trained to conduct coding to assess inter-judge reliability. The four judges had a high level of agreement which was greater than 0.95 for category type. RESULTS: Out of a total of 36,673 respondents, 80% (29,426) submitted written comments at the end of the survey. Of these, 2,178 comments were about medications or health and 170 (8%) comments specifically about CAM, of which 136 (6%) were usable for analysis. Conventional Content Analysis revealed five themes:1)The role of pharmaceutical and insurance companies in CAM; 2) Overuse of medications; 3)Physicians can play a role in creating a balance between prescription use and CAM; 4) Individuals believe that CAM is more effective than Western medicines and prefer it; 5) Individuals want pharmacists to have a better understanding of CAM. Theresults of this study reveal individuals' opinions regarding how they want CAM to be considered in their interactions with their healthcare team. CONCLUSION: Emergent themes suggest that individuals are interested in receiving more professionals' healthcare to become more knowledgeable about CAM.

Prevalence and Predictors of Herbal Medicine Use Among Adults in the United States.

OBJECTIVE: To describe the prevalence of herbal medicine use among US adults and to assess factors associated with and predictors of herbal use. DESIGN: The data for herbal products use were collected from the 2015 National Consumer Survey on the Medication Experience and Pharmacists' Roles. Chi-square test was used to analyz factors associated with herbal use, and predictors of herbal use were assessed with logistic regression analysis. RESULTS: Factors associated with herbal supplement use include age older than 70, having a higher than high school education, using prescription medications or over-the-counter (OTC) medications, and using a mail-order pharmacy." All Disease state associated significantly with herbal use. Approximately thirty-eight percent of those who used herbals used prescription medications and 42% of those who used herbals also used an OTC medication. The most frequent conditions associated with herbal supplement use were a stroke (48.7%), cancer (43.1%), and arthritis (43.0%). Among herbal product users, factors that predicted use included having higher than school education, using OTC medications, using mail-order pharmacy, stroke, obesity, arthritis, and breathing problems. CONCLUSIONS: More than one-third of respondents reported using herbal supplements. Older age and higher education were associated with a higher use of herbal supplements. People with chronic diseases are more likely to use herbal medicines than others. OTC drug users and patients with stroke are more likely to use herbal medicines than others.

Establishing pathways for access to pharmacist-provided patient care.

OBJECTIVE: To describe the pathways being established for access to pharmacist-provided patient care and supply recommendations for the next steps in this process. DATA SOURCES: A series of reports published by the American Pharmacists Association regarding pharmacist-provided patient care services. SUMMARY: Community pharmacies and integrated health organizations have emerged as the two predominant pathways for patient access to pharmacist-provided patient care. We view these two pathways as complementary in helping cover patients' entire medication therapy needs as they traverse acute and chronic health care services. However, gaps in access to pharmacist-provided care remain, especially during transitions in care. CONCLUSION: In further establishing pathways for access to pharmacist-provided patient care, we propose that the application of collaboration theory will help close gaps that currently exist between health care organizations. Such an approach carries risk and will require trust among participating organizations. This approach is also likely to require updating and contemporizing pharmacy practice acts and other statutes to allow pharmacists to practice at maximum capacity within new models of care. To perform their new roles and create sustainable business models to support these new functions, pharmacists will need to be paid for their services. To this end, changes will need to be made to payment and documentation systems, incentives, and contracting approaches to develop proper reimbursement and accounting for pharmacists' new roles.

Positioning and integrating medication therapy management.

OBJECTIVES: To summarize findings from medication therapy management (MTM) "environmental scans" conducted from 2007 through 2010, interpret findings from the environmental scans using insights gained from the Future of MTM Roundtable convened in October 2010, and propose ideas for future positioning and integrating of MTM programs in the U.S. health care system. METHODS: Data for the environmental scans were collected from purposive samples of MTM pharmacist providers and MTM payers throughout the United States using self-administered online surveys in 2007, 2008, 2009, and 2010. RESULTS: Based on the findings, it appears that MTM is becoming more developed and that some aspects of MTM have become established within the organizations that are providing and paying for these programs. However, the findings also revealed that a need exists to better integrate MTM between organizations and patients serviced (business-to-consumer relationships), between partnering organizations (business-to-business relationships), and between collaborating practitioners (peer-to-peer relationships). CONCLUSION: The findings suggest that a "channel of distribution" is emerging in which organizational relationships and cost efficiencies will be important considerations in the near term. We propose that applying (1) customer portfolio management and (2) transaction cost economics would help improve positioning and integrating MTM into the U.S. health care system.

Pharmacists' personal use, professional practice behaviors, and perceptions regarding herbal and other natural products.

OBJECTIVES: To characterize pharmacists' personal and family use of, professional practice behaviors regarding, and perceptions of herbal and other natural products (H/NPs), and to ascertain whether these characteristics differ by pharmacists' education, practice setting, and other demographic characteristics. DESIGN: Descriptive study. SETTING: Minnesota. INTERVENTION: Cross-sectional questionnaire mailed in June 2000. PARTICIPANTS: A random sample of 1,017 pharmacists with active Minnesota licenses. RESULTS: Of the 533 respondents, 282 (53%) reported personal use of H/NPs, and 240 (45%) reported having recommended H/NPs to a family member. Pharmacists working in community/outpatient settings and pharmacists living in nonurban areas were more likely to report H/NP use. Patients' requests, consumer demand, manufacturer's reputation, and manufacturer's ability to provide product quality data were key factors influencing respondents' decisions to purchase and stock H/NPs in the pharmacy. Trade journals/professional newsletters, continuing education coursework, reference texts, and reports of randomized clinical trials were considered very important sources of information about H/NPs. However, almost all respondents (95%) felt available information on H/NPs was "not adequate" or only "somewhat adequate." Half the pharmacists (51%) believed that H/NPs were safe, but only 19% believed they were effective. Slightly more than half of the respondents (56%) reported suggesting to a patient that he or she try an H/NP. The amount of government oversight of H/NPs was considered "not adequate" by 78% of pharmacists. On average, pharmacists reported that patients ask them questions regarding H/NPs 7 times per 40-hour workweek; other health care practitioners ask an average of 1.3 times per week. CONCLUSION: Pharmacists' personal use of H/NPs is as high or higher than that of other groups of Americans, and they use similar products. Decisions to stock H/NPs in a pharmacy are influenced by consumer demand and concern for product quality. Pharmacists desire more information on H/NPs and more government oversight of these products, and pharmacists are increasingly being sought out as sources of information regarding H/NPs.