Factors influencing patient participation in medication counseling at the community pharmacy: A systematic review

Background: Findings document that patient participation in pharmacy encounters is associated with favorable outcomes. However, there is a need to understand factors that may enhance or hinder patient engagement and pharmacist counseling behaviors during their medication discussions. This review aims to: (1) identify barriers and facilitators for patient engagement in pharmacy consultations, (2) explore the relationship between patient factors (such as demographics and communication behavior) and subsequent pharmacist counseling behavior. Methods: A systematic review of literature using PRISMA guidelines examined studies published in English addressing influences on patient participation and the relationship between patient factors and pharmacist counseling behavior. Four databases were used - PubMed, CINAHL, PsycINFO, and Scopus. Findings were framed thematically within the constructs of Street's Linguistic Model of Patient Participation in Care (LM). Findings: Fifty studies from 1983 to 2019, including 37 using self-reported data, were identified. Patient involvement in patient-pharmacist communication was influenced by enabling factors such as patient knowledge, communication skills, and pharmacy environment. Predisposing factors for participation ranged from patients' beliefs and past experiences to demographic characteristics such as gender and age. Pharmacists' participative behavior with patients was positively associated with patients' engagement and perceived patient cues in the conversation. Conclusion: This systematic review identified predictors of patients' engagement in pharmacy encounters drawing on LM framework. Various predisposing factors, enabling factors, and pharmacist' responses impacted patients' willingness to actively participate in medication counseling at community pharmacies. Equally important, studies documented considerable impact by patients on pharmacists' counseling behavior. Pharmacy encounters should no longer be viewed as controlled simply by pharmacists' expertise and agendas. Patient characteristics and factors such as patient question-asking and expectations also appear to be associated with and influence patient-pharmacist interpersonal communication. Additional research needs to address the identified facilitators and barriers to enhance patient participation and pharmacist counseling behavior.