BMJ  2007;334:1101 (26 May), doi:10.1136/bmj.39171.577106.55 (published 20 April 2007)

Research

"I haven't even phoned my doctor yet." The advice giving role of the pharmacist during consultations for medication review with patients aged 80 or more: qualitative discourse analysis

Charlotte Salter, lecturer in consultation skills1, Richard Holland, senior lecturer in public health medicine1, Ian Harvey, professor of epidemiology and public health1, Karen Henwood, senior lecturer2

1 School of Medicine, Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ, 2 School of Social Sciences, Cardiff University, Cardiff

Correspondence to: C Salter c.salter{at}uea.ac.uk

Objective To explore the advice giving role of pharmacists during consultation for medication review with patients aged 80 or more.

Design Discourse analysis.

Setting Participants' homes.

Participants Subsample of consultations within a large randomised trial of home medication review among patients aged 80 or more who had been admitted to hospital.

Main outcome measures Extent to which advice given by pharmacists was accepted and acknowledged by patients.

Results Pharmacists found many opportunities to offer advice, information, and instruction. These advice giving modes were rarely initiated by the patients and were given despite a no problem response and deliberate displays of competence and knowledge by patients. Advice was often resisted or rejected and created interactional difficulties and awkward moments during the consultations.

Conclusions The advice giving role of pharmacists during consultations with patients aged 80 or more has the potential to undermine and threaten the patients' assumed competence, integrity, and self governance. Caution is needed in assuming that commonsense interventions necessarily lead to health gain.


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