Addressing Hidden Curricula That Subvert the Patient-Centeredness “Hub” of the Pharmacists’ Patient Care Process “Wheel”

Abstract

Objective. This systematic review's purpose is to improve clarity for the meaning of patient-centered care in the JCPP Pharmacists' Patient Care Process referenced in ACPE Standard 10.8, and provide an initial foothold for faculty to address "hidden curricula" that undermine the concept. Our corresponding objectives were to (1) identify and describe the conceptualizations defining patient-centered care from the pharmacy literature; and (2) compare the meaning of patientcenteredness in the pharmacy literature with the construct's seminal conceptualizations from other professional groups. Findings: The search protocol produced 61 unique sources from the pharmacy literature. More than two-thirds of these results lacked precise use of terminology consistent with the literature or operational depth or theoretical exploration of the term's meaning. The remaining sources yielded two separate conceptualizations of patient-centeredness with three commonalities, but key differences between their grounding in the construct's seminal sources in the broader health care literature. Summary: The pharmacy literature clarifies the meaning of patient-centered care in the patient-pharmacist encounter, but additional understanding is needed at the meso-(ie, health care systems) and macro-levels (ie, legislation, accreditation, payment, workforce dynamics) of care. This expansion of understanding may reduce dissonance between the formal and hidden curricula on patient-centeredness associated with health professional student disillusionment, contempt for faculty and institutions, and reductions in empathy and ethics. Increasing use of integrative case-based training, equitably blending patient-centeredness considerations with other curricular content, represents one strategy for reducing the presence and negative impact of hidden curricula.

An exploratory QUALquan comparison of patient‐centeredness priorities in outpatient Care for Patients and Pharmacists

“…Directed content analysis of 439 excerpts (unit of analysis) produced 13 superordinate codes representing the meaning of patient-centeredness in pharmacist care consistent with the PPCP and the literature. 9,10 The applicability and comprehensiveness of the a priori coding scheme were sufficient to avoid adding new inductively generated codes. Both figures display parallel findings between the patient-only and pharmacist-only datasets for 7 of the top 10 superordinate concepts.…”

“…The most frequently coded superordinate concept in the Pharmacist‐only dataset was “Care Coordination and Integration” and is not well‐represented in the pharmacist patient‐centeredness literature 9,10 . Patients in the sample ranked this superordinate concept considerably lower than pharmacists.…”

“…The multi‐dimensional nature of patient‐centeredness has been studied extensively for over 50 years, particularly in the fields of medicine, nursing, and health policy. Pharmacist conceptualizations of patient‐centeredness come primarily from medicine, which is characterized by guiding principles for consideration by the clinician to understand the patient's perspective and facilitate desirable clinical outcomes (Table 1; see Data S1 for coding definitions and descriptions Additional information about concepts can be requested from Olson and colleagues) 9,10 . Less represented in pharmacist conceptualizations of patient‐centeredness are concepts reflecting a health care systems‐oriented approach that adjusts the care context to meet the unique needs of the patient.…”

“…The corresponding author proceeded to recruit these prospective participants as well as assess their eligibility for the study using the criteria described above. A purposive national sampling strategy was employed to include pharmacists in states that allowed modification of drug therapy by pharmacists, and that were representative of four distinct geographic regions (ie, East Coast, Midwest, T A B L E 1 Level of care for 40 seminal patient-centeredness concepts from three health profession fields and their relationships with the pharmacist literature [9][10][11][12][13][14] all patient care settings involving pharmacists. The criteria were also selected to recruit pharmacists and patients in contexts more likely to be involved in care that could be characterized as patient-centered.…”

“…Pharmacist conceptualizations of patient-centeredness come primarily from medicine, which is characterized by guiding principles for consideration by the clinician to understand the patient's perspective and facilitate desirable clinical outcomes (Table 1; see Data S1 for coding definitions and descriptions Additional information about concepts can be requested from Olson and colleagues). 9,10 Less represented in pharmacist conceptualizations of patient-centeredness are concepts reflecting a health care systems-oriented approach that adjusts the care context to meet the unique needs of the patient. This perspective expands the focus of care from the patient-provider encounter (ie, micro-level) to the level of health systems (ie, meso-level) and considers even more upstream factors like workforce dynamics, accreditation, and payment (ie, macro-level).…”