Patient-Pharmacist Communication Gaps Hinder Medication Understanding and Adherence

Despite pharmacists consistently covering the essentials of medication counseling, patients are not always walking away with the right message, pointing to a critical gap between information delivered and retained, according to a study in JAPhA Practice Innovations.¹

“Pharmacists are often the last health care provider a patient interacts with prior to taking their medications,” wrote the authors of the study. “As such, pharmacists are essential in addressing education gaps, clarifying any concerns, and reinforcing the importance of medication adherence.”

A recent study of 87 pharmacist-patient pairs in Texas grocery store pharmacies reveals a significant disconnect in medication counseling that could impact patient safety. Although pharmacists and patients nearly always agreed that essential topics like dosing and administration were discussed, they only agreed on what the key takeaway message was 43% of the time.¹

This research suggests that, even though pharmacists are reliably checking the boxes of required information delivery, patients may not be internalizing the most critical details.

The perception gap is not unique to the Texas setting either. A comprehensive cross-sectional survey in Nigeria involving 125 community pharmacists and over 600 pharmacy customers found a similar disparity, according to the Journal of Pharmaceutical Policy and Practice.²

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Although pharmacists rated the quality of their counseling as satisfactory, patients viewed those same interactions as unsatisfactory. The most significant differences in the Journal of Pharmaceutical Policy and Practice study appeared in how the 2 parties viewed the discussion of medication history, allergies, and the integration of drug regimens into daily routines.

A primary driver of this misalignment is the challenge of health literacy. Only 12% of the US population is considered proficient in health literacy, meaning the vast majority of patients struggle to integrate complex medical information or perform multi-step mathematical problems, according to the American College of Clinical Pharmacy.³

Consequently, clinical experts recommend a universal precautions approach, assuming every patient may have limited literacy regardless of their background or appearance. Tools such as the Single Item Literacy Screener (SILS) or the Newest Vital Sign (NVS) are increasingly recommended to help pharmacists quickly assess a patient's capacity to process instructions during encounters.^3,4

To bridge these communication gaps, pharmacists are encouraged to move away from a traditional information delivery model toward more interactive strategies. Techniques such as motivational interviewing prioritize collaborative, goal-oriented exploration to address patient uncertainty.⁴

By employing the open-ended questions, affirmations, reflective listening, and summarization (OARS) technique, pharmacists can build trust and ensure patients feel heard. Furthermore, using the teach-back or show-me methods is essential for verifying that the patient's understanding matches the pharmacist's intent.^3,4

The persistent variability in counseling quality has sparked a global debate over the need for standardization. With laws in many jurisdictions, including Texas, obligating pharmacists to counsel on new prescriptions, these requirements are often written at a very general level.^1,5

Scholars suggest that although standards could ensure a baseline of quality, they must not inhibit the pharmacist’s ability to provide tailored, patient-centered care that meets individual needs.⁵

For specific populations, such as older adults who may process information more slowly or have cognitive impairments, pharmacists must adapt their styles. This may involve using briefer sessions, emphasizing key points with high-contrast visual aids, and following up more frequently.³

For patients dealing with emotional distress related to a new diagnosis, the BATHE method—focusing on background, affect, troubling issues, handling, and empathy—can help the pharmacist acknowledge emotions and maintain rapport while gathering essential history.

The Texas study underscores that the mere delivery of information does not guarantee effective communication.¹

As pharmacists are often the final health care providers a patient interacts with before taking a medication, the goal must shift from a one-way lecture to a confirmed partnership.^1,3 Ensuring that the patient's key takeaway aligns with clinical priorities is paramount to truly improving medication adherence and long-term health outcomes.^1,5

“This study highlights the fact that pharmacists consistently address essential topics, including the purpose, administration, side effects, and adherence to medication, and patients are largely aware of this communication,” concluded the authors of the current study.¹ “However, the suboptimal concordance on the key takeaway message from patients and pharmacists suggests a potential gap in how well patients internalize or recall the information provided.”

READ MORE: Tennessee’s Pharmacist Scope Expansion to Improve Access to Care

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REFERENCES

1. McKenzie K, Stallings AR, Unni E. Assessing the effectiveness of patient-pharmacist communication during medication counseling in Texas community pharmacies. JAPhA Pract Innov. March 2, 2026:100106. https://doi.org/10.1016/j.japhpi.2026.100106

2. Showande SJ, Laniyan MW. Patient medication counselling in community pharmacy: evaluation of the quality and content. J Pharm Policy Pract. 2022 Dec 16;15(1):103. doi: 10.1186/s40545-022-00502-3.

3. Mcconaha JL, Prosser TR. Communication strategies in pharmacy. American College of Clinical Pharmacy. 2017. Accessed March 17, 2026. https://www.accp.com/docs/meetings/UT17/handouts/02._Communication_Strategies_in_Pharmacy.pdf

4. Nguyen KT, Warunek L. Pharmacy communication strategies. StatPearls Publishing. April 15, 2024. Accessed March 17, 2026. https://www.ncbi.nlm.nih.gov/books/NBK603742/

5. Hämeen-Anttila K, Mikkola H. Is there a need for standardization of medication counseling in community pharmacies? RSAP. 2024;20(5):547-552. https://doi.org/10.1016/j.sapharm.2024.02.005