Dispensing-Module 6- Patient Counseling and Patient Medication Profile

Pharmacists… (APhA Code of Ethics)

• Are health professionals who assist individuals in making the best use of medications
• Promise to help individuals achieve optimum benefit from their medications, to be committed to
their welfare and to maintain their trust
• Promote the right of self-determination and recognize individual self-worth by encouraging
patients to participate in decisions about their health
• Communicate with patients in terms that are understandable
• In all cases, respect personal and cultural differences among patients
• Shall personally initiate discussion of matters which will enhance or optimize drug therapy
with each patient

New Responsibility of Pharmacists…

 Changes in standards and legislation made the provision of information a responsibility
 The Pharmacist Practice Activity Classification [PPAC] developed by APhA describes pharmacist’s
activities that involved patient interaction
New Tasks for Pharmacists
 Interviewing the patient
 Obtaining patient information
 Educating the patient
 Providing verbal and written communication
 Discussing
 Demonstrating
 Face-to-face patient contact
 Patient counseling

Patient Counseling definition…

• A key competency element of the pharmaceutical care process which involves provision of
appropriate, understandable and relevant information to patients about their medications
through oral or written form
Patient Counseling
• Providing medical information verbally or in written form to the patients or their
representatives on directions of use, advice on side effects, precautions, storage, diet and
lifestyle modifications
• It is a two-way communication process whereby drug- and health-related information is
provided by a pharmacist to the patient during…
• the dispensing of (initial or refill) medications in a drugstore or outpatient pharmacy
setting
• discharge of a patient from the hospital
• the review of medications of a patient

Functions of Patient Counseling

 Improve patient care
 Provide professional pharmacy services
Patient Counseling to Improve Patient Care
 Better patient understanding of their illness and the role of medication in its treatment
 Improved medication adherence
 More effective drug treatment
 Reduced incidence of adverse effects and unnecessary healthcare costs
 Better coping strategies to deal with medication related adverse effects
 Improved quality of life for the patient
 Improved professional rapport between the patient and pharmacist

Providing Professional Pharmacy Services through Patient Counseling

 Provides compliance with pharmacy legislations, standards and regulations
 Affords legal protection, since pharmacists may be held accountable for injury resulting from
insufficient information provided to the patient
 Maintains professional status as part of primary care and health care team
 Increases job satisfaction and reduces stress
 Is an added service to meet patient demand and aid in market competition
 Increases revenue through payment of counseling services and reduces loss resulting from
unfilled or unrefilled prescriptions

WHO and WHEN to counsel…

• The amount and type of information provided to the patient will vary based on the patient’s
needs and practice setting.

Patients Who Should ALWAYS Be Counseled…

• New patients, or those receiving a medication for the first time
• Children and parents receiving medication
• Patients receiving medication with special storage requirements, complicated directions

COUNSELING AREA
• Semi-private or private area, away from other people and distractions
• Patient should perceive the counseling area as confidential, secure and conducive to learning
• Focused discussion, minimized interruptions and patient participation

Communication Skills for Better Counseling

• Counseling uses verbal and non-verbal communication skills
• Verbal Communication Skills
– Language
– Tone
– Volume
– Speed
• Non-Verbal Communication Skills
– Proximity
– Facial expression
STAGES OF PATIENT COUNSELING
• Patient Counseling consists of three stages or parts:
1. Introduction
2. Process Content
3. Conclusion
Introduction
• Review the patient’s record
• Introduce yourself
• Explain purpose of counseling
• Obtain drug related information such as allergies, use of herbals etc.
• Assess the patient’s understanding of the reasons for therapy
• Assess any actual/potential concerns or problems of importance to the patient
Process Content
• Use language that the patient understands
• Use appropriate counseling aid
• Present facts and concepts in simple words and in logical order
• Use open-ended questions
Conclusion
• Verify the patient’s understanding by means of feedback
• Summarize by emphasizing key points
• Give an opportunity to the patient to put forward any concerns
• Help the patient to plan follow up

Counseling Content
• The counseling content is considered to be the heart of the counseling session.
• It is during this step that the pharmacist explains to the patient about his or her medications
and treatment regimen and other related matters.

• Name and strength of medication

• Reason why it has been prescribed or how it works
• How to take the medication
• Expected duration of treatment
• Expected benefits of treatment
• Possible adverse effects
• Possible medication or dietary interaction
• Advice on correct storage
• Minimum time duration showing therapeutic benefit
• What to do if a dose is missed
• Special monitoring requirements, e.g. blood tests
• Arrangements for obtaining further supplies
Documentation
• Document PEC in patient’s permanent medical records.
• The pharmacist should record:
– That counseling was offered and was accepted and provided or refused
– The pharmacists’ perceived level of the patient’s understanding
• All documentation should be safeguarded to respect patient confidentiality and privacy and to
comply with applicable state and federal laws.
Educational Methods and Counseling Aids
EDUCATIONAL METHODS
Lectures
◼ Traditional style of presenting information
◼ Limited to large groups
◼ Often boring and retention of listeners is fairly low
◼ Incorporate other educational techniques such as audiovisual aids
◼ Public speaking is one of the best ways to gain public trust for the profession and to serve
patients
Dialogue and Discussion
◼ One-on-one dialogue with the patient through patient counseling is the essence of the
pharmacist’s regular duties
◼ The discussion maybe guided by the pharmacist, but should allow for as much participation as
possible by the patient
◼ More time consuming but is more effective in improving the patient’s understanding of
medication use and in altering patient’s attitudes
Printed Information
◼ Gives brief knowledge about the medication
◼ Understanding of information depends on patient’s level of comprehension
◼ Not effective if not combined with discussion and lecture
Audiovisual Materials
◼ Involves the use of sound and slide shows, audiotapes, videotapes, comic books
◼ Used with one patient or with small groups
◼ More effective when combined with discussion
◼ A viewing area can be set up in the pharmacy, in the waiting area or preferably in an area with
some privacy
◼ Expensive but can be used repeatedly
◼ Effective in improving patient knowledge and skills as well as patient satisfaction
◼ AV materials should be reviewed and evaluated by the pharmacist to determine appropriateness
of the material
Demonstration & Practice Techniques
◼ A superior and effective method useful when a medication requires a particular technique of
administration
◼ Done by demonstration by the pharmacist or by videotape
◼ Allow patients to practice the technique to develop requisite skill
◼ Clarifies procedures
◼ By observing the patient practicing, the pharmacist can detect possible errors and subsequently
correct them
Computer-Assisted Patient Education
◼ With the increased availability and ease of development of software, computer-assisted
programs became available to assists pharmacist in providing general information as well as
information about health and medication topics
◼ A type of educational method that is useful for pharmacists in assessing patient’s educational
needs
◼ An example is a trial of a computer-assisted lesson on general drug knowledge in a quiz format
Miscellaneous Methods
◼ Recording of symptoms in a diary
◼ Listing of questions to ask the physician
 ◼ Talking to patient support groups
◼ Written or verbal contract between the patient and the pharmacist

COUNSELING AIDS
• Are use to assist the patient.
• May reduce noncompliance by simplifying multiple drug regimen
• Helps in overcoming difficulties resulting from cognitive or physical impairments

Medication – Reminder Card

• It consist of a calendar on which each day is divided into sections according to the number of
doses to be taken.
Assisted Labeling
• For patients with reading difficulties, use a medication-instruction clock
• For patients with impaired vision, provide labels with large print, symbols and Braille
• For patients who find it difficult to interpret instructions or to coordinate dosing of several
medications, use a medication chart
Pill-Reminder Containers
• Assist patients in remembering to take their medications
• These containers are filled by the pharmacist, the patient, a family member or anyone else
involved in the patient’s care
DISADVANTAGE:
• Most only provide 1 compartment per dosing time.
• Do not include spaces for written instructions to be filled out by the pharmacist
• They have no child-proofing mechanism
Unit-of-Use Packing
• Various packing methods can be used that assist patients by providing one dose of medication at
a time
• Medication compliance was found to be significantly better among group of elderly patients
provided with unit-of-use packaging
• Calendar blister-pack system which provided 31 large blister on each card. One card was
provided for each dosing time
eg. 4 cards would be dispensed for 1 month of medication used 4 times daily
DISADVANTAGE:
• Inability to add or delete drugs once a pack is set up
• Minimal flexibility for complex regimens
• Lack of portability
• Higher costs of labor and time in preparation
• Some are difficult for certain patients to open, whereas most lack child-resistance
Dosing Aids
• Patient sometimes have difficulty following exact directions because of problems in making
accurate measurements
• Direction of tablets or liquid measurements may be more accurately followed with the help of
dosing aids
• Dosing aids help patient to accurately measure their medications
Examples
• Pill crushers for tablets
• Calibrated spoons or various liquid dispensers for liquid medications
 • Aero-chambers and masks to help direct inhaled medication into the mouth
Pill crushers
• Devices that accurately divide tablets of all sizes and shapes
• Patients should be advised, however, that these devices cannot be used for
1. sustained-release or
2. long-acting medications or
3. tablets with enteric or protective coating
Calibrated Spoons or Various Liquid Dispenser
• Available for administration of liqiud medication
• This assist in accurate dosing since household teaspoons can range in volume measure from 4 to
7 ml.
Aero-chamber and Mask
• Help direct inhaled medication into the mouth.
• These assist patients in using inhaled medication whom often fail to get complete doses because
they find it difficult to press the inhaler and inhale simultaneously.

Medication Refill Reminder System and Telephone Follow-up

Computerized systems that link to patient records and telephone patients
• Calculates drug usage
• Determines refill dates
• Initiates a telephone call using the actual voice of the pharmacist
• Reminds the patient that the drug needs to be refilled
• Allows additional comments by the pharmacist and accepts the patient’s response

PATIENT MEDICATION PROFILE

• A record of information about a patient’s drug therapy
• A current list of all medications for an individual, any allergies the individual has, and any
information relevant to an individual’s ability to safely take medications
Benefits of Patient Medication Profile
• Helps you better manage your medicines
• Reduces the chance of experiencing any unexpected side effects from your medicines
• Ensures that all members of the health care team know what medicines you are on, especially
OTC and other medicines they may not be aware of
• Allows pharmacist to review all the medications that a patient is taking
• Problems with pharmaceutical therapy can be detected and avoided or corrected
• Therapeutic duplication
• Drug interactions
• Incorrect dosage or duration of treatment
• Possible allergic reaction
• Clinical abuse or misuse
Components Patient Medication Profile
• Patient Information
– Name, age, gender, height, weight
• Allergies
– Drug, environment, food
– Medical Information
– Chief complaint, past medical history, family history
• Social History
– Use of tobacco and alcohol
• Medication List
– Date - Indication
– Name of medicine - Response
– Dosage strength - Remarks
– Frequency
– Route