Year 3

2013
“Keep watch also on the fault of patients which
often makes them lie about taking of things
prescribed”
Remarks credited to Hippocrates
Awareness of noncompliance 2000 years ago!

“The basic and most common cause of

noncompliance is the patient who does not
understand what is expected”
Franck E. Young, MD, PhD, Commissioner of the FDA
 Key competency element of pharmaceutical
care process
◦ Essential to improve use of medications
 Involves a one-to-one interaction between
pharmacist and patient
◦ Interactive in nature
 May be defined as :
◦ providing medication information to the patients or
their representative
◦ providing proper directions of use, advice on side
effects, storage, diet and life style modifications.
 Ultimate goal:
◦ provide information to encourage safe and
appropriate use of medication,
◦ thereby enhancing therapeutic outcomes
 Should include assessment of whether or not
◦ the information was received as intended
◦ the patient understands how to use the information
to improve probability of positive therapeutic
outcome
 Patient’s lack of knowledge (medical condition,
medications) may contribute to non-adherence to
medication
 As a professional, it is your responsibility to make
patient safety a priority
◦ Continuously consider how to make systems within your
practice safer
◦ Particularly given the number of sound-alike and lookalike
drugs or because drug names are sometimes miswritten,
misheard, and misread.
◦ Carefully reviewing medication therapy with the patient
helps to avoid potentially dangerous situations
 Patient counseling can improve patient care
in various ways:
◦ Reducing medication errors
◦ Increasing patients’ understanding and
management of their medical condition
◦ Minimizing incidence of adverse drug reactions and
drug–drug interactions
◦ Improving patient outcomes and satisfaction with
care
 Open communication lines further between
pharmacist and patient:
◦ allow the pharmacist to give better health care as he is better
informed of the patients’ overall health, and can further help
the patient in leading a healthier life.

 With the huge workload, often patient counseling is

neglected, adding to the problem of dispensing
errors
 Effective patient counseling can significantly reduce
patient non-adherence, treatment failure, and
wasted health resources
Patient counseling has 3 main objectives:
 Assessing the patient’s understanding of the therapy,
including proper use and adverse effects of the medication
◦ Patient should recognize the importance of medication for his well
being
◦ Patient’s understanding of strategies to deal with medication side
effects and drug interactions should be improved
 Improving patient adherence
 Motivating the patient to take an active role in health
management
◦ Patient becomes an informed, efficient and active participant in
disease treatment and self care management.

The pharmacist should be perceived as a professional who

offers pharmaceutical care
Patient counseling consists of three stages:
1. Introduction
2. Process content
3. Conclusion
 Review the patient’s record
 Obtain drug related information such as

allergies, use of herbals etc.

 Assess the patients understanding of the

reasons for therapy

 Assess any actual and/or potential concerns

or problems of importance to the patient.

Medication information exchange
◦ Use language that the patient understands
◦ Use appropriate counseling aids
◦ Present facts and concepts in simple words and in
logical order
◦ Use open ended questions
 Check patient understanding (feedback)
 Summarize by emphasizing key points
 Give opportunity to the patient to put forward

any concept
 Help the patient to plain follow-up
 Key points to cover during counseling:
◦ Name, strength, dosage, route of administration, purpose
and expected benefit of the medication
◦ How and when to take the medication
◦ Adverse effects associated with the use of the medication,
including their avoidance, and the action required if they
occur
◦ Potential precautions, contraindications, drug-drug
interactions including non-prescription and herbal drugs
◦ Techniques for self-monitoring drug therapy
◦ Proper storage
◦ Prescription refill information
◦ What to do if a dose is missed
◦ Ask if the patient has any questions or concerns
 Establish relationship – show interest in patient (verbal &
nonverbal)
 Verify patient's name and prescriber's name
 Why the patient is being prescribed the medication (if known)
or the medication’s use, expected benefits and action
 Open the medication containers and show patient what the
medication looks like, or demonstrate use
 How to take the medication, when to take and how long
 What to do if a dose is missed
 Any special precautions to follow
 Foods, alcoholic beverages or OTC’s to be avoided
 How the patient will know the medication is working
 How to store the medication
 If the prescription can be refilled, and if so, when
 Verify the patients’ knowledge and understanding
 Ask the patient if they have any questions
 Document the interaction
 New patients, or those receiving a medication
for the first time
 Patients whose profile shows a change in
medications or dosing
 Patients receiving medication with special
storage requirements, complicated directions,
significant side effects
 Confused patients, and their caregivers
 Patients who have visual, hearing or literacy
problems
 Children and parents receiving medication
 Pharmacists often view counseling as a one-way
process
◦ "tell" or "lecture" the patient about his or her medication
◦ > no information flow from the patient back to the
pharmacist
 A two-way discussion has the potential to positively
affect patients' understanding and compliance
◦ although it may be more time-consuming
 Important to involve the patient in the counseling
discussion to better assess what the patient knows or
needs to know
 The nature of the counseling should be
tailored to the patient population
 A good counselor is one who

◦ listens to the patient carefully

◦ shares problems intimately so that the patient
expresses the emotions underlying the disease
 During counseling pharmacist should be
totally involved in the counseling and should
not be half minded
◦ Even attending a telephone call while counseling
may affect the quality of counseling.
 An effective counseling will end up with
several questions being asked by the patient
 Throughout the counseling process, the

pharmacist should avoid jargons and slang

expressions
The Indian Health Services Model :
 3 prime questions to ask patients who are receiving
a new prescription:
◦ What did your doctor tell you the medication is for?
◦ How did the doctor tell you to take it?
◦ What did the doctor tell you to expect?
 Final verification or asking the patient for feedback
◦ Just to make sure that I didn’t leave anything out, please
tell me how you are going to take your medication?

 IHS model utilizes open-ended questions (3 prime

questions) and feedback (final verification) strategy
◦ make communication more efficient and engaging
 Other strategies can help make the
pharmacist-patient encounter more
meaningful:
◦ Active listening (focusing on the patient)
◦ Eye contact (being attentive, but not staring)
◦ Being aware of your own body language (facing the
patient and giving them your undivided attention)
◦ Recognizing and interpreting nonverbal cues from
the patient (comparing their nonverbal behaviors to
their verbal communication)
◦ Being aware of barriers that prevent a good
exchange (lack of privacy, interruptions, noise, etc)
1. Establish Trust
◦ Pharmacists are among the most accessible and
trusted health care professionals.
◦ Introduce yourself with a brief, friendly greeting to
make patients feel comfortable enough to ask
questions about their medication therapies and
health conditions.
◦ Pharmacists who demonstrate a genuine interest in
patient care are more likely to encourage dialogue.
2. Communicate Verbally
◦ Encourage dialogue by asking questions.
◦ Assess what the patient already knows about his or her
chosen therapy and tailor the counseling to meet the needs
of each individual patient.
◦ Ask patients what their physician has told them about the
selected therapy and the condition for which they are being
treated.

3. Communicate Nonverbally
◦ Maintain eye contact with the patient,
◦ Demonstrate interest in the information the patient is
relaying.
◦ Be cognizant of other nonverbal clues, such as facial
expressions and tone of voice, when interacting with
patients.
4. Listen
◦ Listening to the concerns, questions, and needs of the patient is
essential.
◦ Passive listening:
pharmacist enables the patient to communicate without interruption.
◦ Acknowledgment (such as nodding) - Encouragement ("yes“, "go
on“): alerts the patient that the pharmacist is indeed listening.
◦ Active listening:
involves 2-way interactions between the patient and the pharmacist.
should always be implemented after passive listening.

5. Ask Questions
◦ and state the reason for asking certain questions (so as not to offend
the patient)
◦ Open-ended questions: enables pharmacists to gather more
information that may lead to other questions and/or provide
valuable information to the pharmacist to further assess the patient.
6. Remain Clinically Objective
◦ Make every possible effort to be nonjudgmental and
impartial, to focus on patient care, and to maintain a
professional demeanor.

7. Show Empathy and Encouragement

◦ Patients may feel more comfortable discussing, thus enabling
the pharmacist to obtain pertinent information on their needs
and concerns.
◦ Emphasizing to patients the importance of adherence to
medication regimens
 can promote positive therapeutic outcomes and motivate patients
to take an active role in the management of their health.
◦ Remind patients to call the pharmacy or their physician with
any concerns about their medications.
8. Provide Privacy and Confidentiality
◦ Helps enable patients to feel comfortable discussing
personal medical issues.
◦ Pharmacists can reassure patients of privacy by monitoring
voice levels and counseling patients away from the
dispensing area.
9.Tailor Counseling to Meet Patient Needs
◦ Critical
◦ Pharmacists should be aware of patients with disabilities
and be prepared to treat them with respect and
understanding.
◦ When the medication therapy involves certain administration
techniques (ex: use of an inhaler): demonstrate the proper
technique to ensure that patients are adequately trained.
10. Motivate Patients to adhere to their
medication regimens
◦ By discussing the benefits of medication adherence,
offering support, and explaining the pros and cons
of treatment.
◦ Ex with diabetic patient: stress importance of
maintaining tight glycemic control to decrease or
prevent the complications associated with diabetes.
◦ Information always should be relayed positively
◦ Pharmacists should look continually for ways to
inspire patients to learn more about their treatment
plan.
 Assess the patient by interview and
observation
 Differentiate self-treatment from a medical

referral depending on how the patient

presents.
◦ Apply critical thinking skills
◦ Take a mini-history: essential component of the
nonprescription drug consult
1. Patient history should be taken
◦ brief past medical history, current medications, main complaint
◦ any concurrent problems and impact on their activities of daily
living, and past treatment strategies.
 e.g. other diseases, drugs, contraindications, allergies
2. Decide whether the patient should self-treat or be referred to
a physician
◦ If the patient can be safely self-treated: make a recommendation
regarding which nonprescription product is most appropriate
3. Once the product is selected:
◦ counsel on the nonprescription product’s appropriate use, when
to expect symptom relief, potential side effects, and how to dose
the medication.
◦ indicate when pharmacist will follow-up with the individual, what
patient parameters should be monitored, and how long the
patient should self-treat.
 Perform an adequate mini-assessment of the client’s problem :
◦ identifying the person who will be using the product + approx. age;
◦ any current medical conditions;
◦ current prescription and non-prescription drug use (incl. herbal
products);
◦ symptoms and duration of the complaint;
◦ any medication allergies;
◦ asking whether the client has consulted a health care professional
about the problem.
 You should refer the client for medical attention if:
◦ their condition is potentially severe,
◦ they are uncertain about their symptoms,
◦ their self-diagnosis is likely incorrect,
◦ the condition has not responded to previous appropriate therapy, or
◦ they have other risk factors that should be assessed.
 During the course of a pharmacist’s busy day, it is impossible
to counsel every patient.
 Pharmacists should seize every opportunity to
◦ counsel patients about their treatment regimens
◦ ensure that patients clearly understand the proper use of their
medication.
 Establishing caring relationships encourages patients to seek
counsel.
 Every time a pharmacist takes the opportunity to counsel
patients, he or she empowers patients with the information
necessary to impact the quality of their health.
 Although every pharmacist has a different perception of what
patient counseling should entail, all pharmacists should strive
for one goal when counseling patients: to ensure that
patients are well informed about the proper use of their
medications