title: Knowing the patient: A qualitative study on care-taking and the clinical pharmacist-patient relationship.
abstract: BACKGROUND
  Previous studies have found clinical pharmacists (CPs) and clinical pharmacy specialists (CPSs) in direct patient care have positive effects across various patient outcomes. However, there are also other kinds of care-taking occurring in pharmacy-run clinic appointments that produce value for patients.
  
  
  OBJECTIVE
  To identify and characterize how CPs/CPSs in direct care clinics develop and practice care-taking behaviors which advance the pharmacist-patient relationship.
  
  
  METHODS
  Semi-structured CP/CPS interviews were conducted once per year for two years (46 year 1, 50 year 2) along with direct observations of clinical pharmacy work as part of an anticoagulation improvement intervention. Participants were from Veterans Health Administration (VHA) medical centers and VHA community-based outpatient clinics in the Northeastern U.S. Interviews were transcribed verbatim and thematically analyzed using NVIVO 10 software.
  
  
  RESULTS
  It was found that CPs/CPSs practice "knowing the patient" in ways related to, but distinct from this practice in the nursing literature. For CPs/CPSs, knowing the patient occurred over time, and it produced familiarity and trust between CPs/CPs and patients. A reciprocal relationship developed in which patients came to rely on CP/CPSs for other types of assistance. Patterns of knowing the patient and being known by the patient manifested in three distinct ways: 1) identifying the patient's unmet needs, 2) explaining other medications, and 3) helping the patient navigate the system.
  
  
  CONCLUSIONS
  This research identifies an action, knowing the patient, whereby CPs use their knowledge of the patient to deliver individualized care. This study contributes to the developing literature on pharmacist-patient relationships and pharmacist-patient communication.
authors.affiliation: Center for Healthcare Organization and Implementation Research (CHOIR), ENRM Veterans Hospital (152), 200 Springs Road, Bedford, MA 01730, USA. Electronic address: Megan.McCullough@va.gov.
authors.forename: Megan B
authors.initials: MB
authors.lastname: McCullough
authors.affiliation: Center for Healthcare Organization and Implementation Research (CHOIR), ENRM Veterans Hospital (152), 200 Springs Road, Bedford, MA 01730, USA.
authors.forename: Beth Ann
authors.initials: BA
authors.lastname: Petrakis
authors.affiliation: Center for Healthcare Organization and Implementation Research (CHOIR), ENRM Veterans Hospital (152), 200 Springs Road, Bedford, MA 01730, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Gillespie
authors.affiliation: Center for Healthcare Organization and Implementation Research (CHOIR), ENRM Veterans Hospital (152), 200 Springs Road, Bedford, MA 01730, USA.
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Solomon
authors.affiliation: New England VERC, VA Boston Healthcare System, 150 South Huntington Avenue, Jamaica Plain, MA 02130, USA.
authors.forename: Angela M
authors.initials: AM
authors.lastname: Park
authors.affiliation: Clinical Pharmacy Practice Program and Outcomes Assessment, Pharmacy Benefits Management Services, Department of Veterans Affairs, 110 Timber Ln, Ackworth, IA 50001, USA.
authors.forename: Heather
authors.initials: H
authors.lastname: Ourth
authors.affiliation: Clinical Pharmacy Services and Healthcare Services Research, Pharmacy Benefits Management VACO, Department of Veterans Affairs, 1644 Crespo Dr., La Jolla, CA 92037, USA.
authors.forename: Anthony
authors.initials: A
authors.lastname: Morreale
authors.affiliation: Center for Healthcare Organization and Implementation Research (CHOIR), ENRM Veterans Hospital (152), 200 Springs Road, Bedford, MA 01730, USA; Department of Medicine, Section of General Internal Medicine, Boston University, School of Medicine, 72 East Concord St., Boston, MA 02118, USA.
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Rose
mesh_terms: D000328:Adult; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D010361:Patients; D010593:Pharmaceutical Services; D010594:Pharmacies / Q000458:organization & administration; D010595:Pharmacists; D010607:Pharmacy Service, Hospital; D011369:Professional-Patient Relations; D014481:United States; D014493:United States Department of Veterans Affairs
keywords: Clinical pharmacy services; Knowing the patient; Patient care; Pharmacist-patient communication; Pharmacist-patient relationship; Time