Pharmacy World & Science

, Volume 32, Issue 5, pp 601–609 | Cite as

Exploring pharmacist–customer communication: the established blood pressure measurement episode

  • Afonso Neves CavacoEmail author
  • João P. Romano
Research Article


Objective To characterize the communication ritual in the pharmacist–customer dyad during a blood pressure measurement and counselling episode. Setting A Portuguese urban community pharmacy. Method An exploratory, cross-sectional design was used. Participants were purposively selected and data collected via audio recording, as well as demographics and clinical information via questionnaire. Encounters’ verbal content was transcribed verbatim, utterances identified, time stamped, and classified according to a coding scheme of fifteen categories. All data was statistically analyzed using SPSSv17. Main outcome measures Four dialogue structures: speaker turn, interactivity, turn density and turn duration measurements. Results From a total of 51 participants, 72.5% were female with a median age of 66 years. The average systolic blood pressure was 140 mmHg, while the diastolic was 78 mmHg. The blood pressure measurement episode lasted for 5:35 min, with an average of 81 utterances. From all utterances registered, 55.3% were produced by the customer. Visits averaged 38 speaker turns, with an interactivity rate of approximately 7 turns per episode minute. For pharmacists, turn duration averaged 7.0 s and turn density 2.1 utterances. The customers’ turns comprised a mean of 8.0 s, with 2.4 utterances. Longer episodes were related to more speaker turns and greater customer turn density and duration, but lower dialogue interactivity. The interactivity rate was also lower when the customers’ utterances increased. Pharmacists asked more questions (essentially closed ones), while the customers gave more information. No significant associations were observed between elderly/non-elderly and gender in relation to all communication variables. However, an increased number of speaker turns and closed-questions were associated to a higher systolic pressure. Conclusion It seems that pharmacists tend to control the content of the dialogue, while customers have more influence on the visit duration and interactivity. Specific hypertensive episodes induce a higher information search. Since the closed questioning format was prevalent, it seems that open information exchange was limited, mainly serving confirmation purposes rather than having a true exploratory nature. Although talk dominance is balanced, further analysis is required to better inform these results, which would confirm the low interactivity and the reduced information-seeking behaviour showed in the counselling episodes.


Blood pressure measurement Community pharmacy Pharmacist–customer communication Portugal 



The authors would like to thank the community pharmacy ‘Tovar Chaves’ for the collaboration with this study.


No external sources of funding for this work were obtained.

Conflict of interest

There are no conflicts of interest.


  1. 1.
    Shah B, Chewning B. Conceptualization and measuring pharmacist-patient communication: a review of published studies. Res Social Adm Pharm. 2006;2:153–85.PubMedGoogle Scholar
  2. 2.
    Guirguis L, Chewning B. Role theory: literature review and implications for patient-pharmacist interactions. Res Social Adm Pharm. 2005;1:483–507.PubMedGoogle Scholar
  3. 3.
    West R, Turner L. Introducing communication theory: analysis and application. 2nd ed. New York (NY): McGraw-Hill; 2004. ISBN 0-7674-3034-4.Google Scholar
  4. 4.
    Kairuz T, Bye L, Birdsall R, Deng T, Man L, Ross A, et al. Identifying compliance issues with prescription medicines among older people: a pilot study. Drugs Aging. 2008;25(2):153–62.CrossRefPubMedGoogle Scholar
  5. 5.
    Svarstad BL, Bultman DC, Mount JK. Patient counseling provided in community pharmacies: effects of state regulation, pharmacist age, and busyness. J Am Pharm Assoc. 2004;44(1):22–9.CrossRefGoogle Scholar
  6. 6.
    Svarstad BL, Bultman DC, Mount JK, Tabak ER. Evaluation of written prescription information provided in community pharmacies: a study in eight states. J Am Pharm Assoc. 2003;43(3):383–93.CrossRefGoogle Scholar
  7. 7.
    Bradshaw M, Tomany-Korman S, Flores G. Language barriers to prescriptions for patients with limited English proficiency: a survey of pharmacies. Pediatrics. 2007;120(2):225–35.CrossRefGoogle Scholar
  8. 8.
    Roter DL. The Roter Method of Interaction Process Analysis. Baltimore: The Johns Hopkins School of Public Health [Online]. 2006 [cited 2009 Apr 10]. Available from: URL:
  9. 9.
    Montgomery AT, Sporrong SK, Tully MP, Lindblad AK. Follow-up of patients receiving a pharmaceutical care service in Sweden. J Clin Pharm Ther. 2008;33(6):653–62.CrossRefPubMedGoogle Scholar
  10. 10.
    Johnson CL, Nicholas A, Divine H, Perrier DG, Blumenschein K, Steinke DT. Outcomes from DiabetesCARE: a pharmacist-provided diabetes management service. J Am Pharm Assoc. 2008;48(6):722–30.CrossRefGoogle Scholar
  11. 11.
    [The changes in Community Pharmacy]. ROF—The Portuguese Pharmaceutical Society Magazine. 2007;80:6–10.Google Scholar
  12. 12.
    Paoletti V, Raparelli V, Ferroni P, Scarno A, Trinchieri F, Basili S, et al. Arterial hypertension and cardiovascular risk: need for a combined strategy of intervention. Clin Ter. 2008;159(4):269–73.PubMedGoogle Scholar
  13. 13.
    Leonetti G, Cuspidi C. Recent knowledge on the role of diastolic blood pressure in hypertensive patients on treatment. Recenti Prog Med. 2008;99(4):191–9.PubMedGoogle Scholar
  14. 14.
    World Health Organization Regional Office for Europe. Pharmacy-based hypertension management model: protocol and guidelines. Copenhagen: WHO; 2005.Google Scholar
  15. 15.
    Sleath B. Pharmacist question-asking in New Mexico community pharmacies. Am J Pharm Educ. 1995;59:374–9.Google Scholar
  16. 16.
    Sleath B. Pharmacist-patient relationships: authoritarian, participatory, or default? Patient Educ Couns. 1996;28:253–63.Google Scholar
  17. 17.
    Fritsch MA, Lamp KC. Low counseling rates in the Kansas City, Missouri, metropolitan area. Ann Pharmacother. 1997;31:985–91.Google Scholar
  18. 18.
    Kooy MJ, Dessing WS, Kroodsma EF, Smits SR, Fietje EH, Kruijtbosch M, et al. Frequency, nature and determinants of pharmaceutical consultations provided in private by Dutch community pharmacists. Pharm World Sci. 2007;29:81–9.CrossRefPubMedGoogle Scholar
  19. 19.
    Roter DL, Larson SM, Beach MC, Cooper LA. Interactive and evaluative correlates of dialogue sequence: a simulation study applying the RIAS to turn taking structures. Patient Educ Couns. 2008;71(1):26–33.CrossRefPubMedGoogle Scholar
  20. 20.
    Boardman H, Lewis M, Croft P, Trinder P, Rajaratnam G. Use of community pharmacies: a population-based survey. J Public Health (Oxf). 2005;27(3):254–62.CrossRefGoogle Scholar
  21. 21.
    Tully MP, Temple B. The demographics of pharmacy’s clientele—a descriptive study of the British general public. Int J Pharm Pract. 1999;7:172–81.Google Scholar
  22. 22.
    Bennett EV, Jones IF. Investigating health information requests in six community pharmacies. Pharm J. 2000;265:R45.Google Scholar
  23. 23.
    Beers MH, Fletcher AJ, Jones TV, Porter R, Berkwits M, Kaplan JL, editors. The Merck manual of medical information—second home edition. 2nd ed. Whitehouse Station (NJ): Merck Research Laboratories; 2003. ISBN 0-911910-35-2.Google Scholar
  24. 24.
    Widmaier EP, Raff H, Strang K. Vander, Sherman & Luciano’s human physiology—the mechanisms of body function. 9th ed. New York (NY): McGraw-Hill; 2004. p. 394–5. ISBN 0-07-288074-0.Google Scholar
  25. 25.
    Schommer JC. Patients’ expectations and knowledge of patient counseling services that are available from pharmacists. Am J Pharm Educ. 1997;61:402–6.Google Scholar
  26. 26.
    Pilnick A. The interactional organization of pharmacist consultations in a hospital setting: a putative structure. J Pragmat. 2001;33:1927–45.CrossRefGoogle Scholar
  27. 27.
    Deveugele M, Derese A, van den Brink-Muinen A, Bensing J, De Maeseneer J. Consultation length in general practice: cross sectional study in six European countries. BMJ. 2002;325(7362):472.CrossRefPubMedGoogle Scholar
  28. 28.
    Langewitz W, Nübling M, Weber H. A theory-based approach to analysing conversation sequences. Epidemiol Psichiatr Soc. 2003;12(2):103–8.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2010

Authors and Affiliations

  1. 1.Faculdade de FarmáciaUniversidade de LisboaLisbonPortugal

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