Patient Counseling

Patient counselling

Patient counselling: Definition Goal and procedure

Compiled by: Alok Bains

The Effectiveness of medicines depends upon the efficacy of the medication and patient adherence to the therapeutic regimen. Reasons that cause non-adherence to medication are poor awareness of health conditions, chronic disease, polypharmacy, complex therapeutic regimen, long-term therapeutic regimen, poor accessibility to medicines, adverse drug reactions, medication error, medication confusion, not being convinced of the treatment, poor communication between patient and medical professionals, etc.

Medical practitioners have little time to convince patients about prescriptions. This gap is filled by providing pharmaceutical care. Pharmaceutical care assures the right patient taking the right drug at the right dose at the right time. Pharmaceutical care optimizes patients’ medication therapy through Patient counselling. Clinical pharmacists have the ability to educate patients about the importance of adherence to medication through patient counselling. Clinical pharmacists counsel the patient before discharge from the hospital and before dispensing the medication.

Pharmacy Practice Act 2015 under Chapter 4 states three duties of pharmacists. These are

1. Dispensing/Supply of drugs

2. Promotion of Rational use of drugs and

3. Patient counselling.

Definitions

Patient counselling is a one-to-one interaction between the pharmacist and the patient/caregiver to provide oral or written information about the use, side effects, storage, diet and lifestyle modification with the aim to optimize medication therapy.

Goal

The Goal of Patient Counselling: Primary goal of patient counselling is to guide, support and inform patients to optimize the medication therapy. This can be achieved by the following points

1. Education: To educate the patient about the importance of treatment and self-care,

2. Medication Management: To ensure patient understanding about the proper use of the medication and their side effects, adverse effect and drug interactions.

3. Lifestyle modification: To assist the patient to modify lifestyles to improve health and manage chronic conditions.

4. Compliance with medication: To support and convince the patient to adhere to the treatment plan.

5. Emotional support: To provide emotional support to address anxiety, fear and psychological challenges.

6. Goal setting: To collaborate with patients to set realistic health goals.

7. Health Promotion: To encourage patients to adopt prophylactic schedules such as vaccination and regular health checkup.

The ultimate goal is to improve patient pharmacist relationship, enhance patient satisfaction, promotes self-management skill and improves health outcome.

Procedure

It involves a one-to-one interaction between a pharmacist and a patient and/or a caregiver.

Techniques of patient counselling: The United States of Pharmacopoeia (USP) named patient counselling as medication counselling behaviour. It divides medication counselling behaviour into the following steps

1. Stage 1: Transfer of medication information. It includes basic and brief information about the safe and proper use of medicines.

2. Stage 2: Exchange of medication information. The pharmacist shall answer all questions raised by the patient/caregiver.

3. Stage 3: Medication education. Pharmacists provide comprehensive information regarding the proper use of medicines in a collaborative, interactive learning experience.

4. Step 4: Medication counselling. Pharmacists discuss with patients in detail to guide and enhance problem-solving skills and assist with the proper management of medical conditions and effective use of the medication.

Patient counselling contents: Clinical pharmacists perform patient counselling, especially during prescription filling to encourage patient compliance with the medication order. Following steps are followed by the clinical pharmacists for patient counselling

1. Introduction: The pharmacist shall greet the patient in a warm friendly manner. He/she will introduce himself/herself to establish a rapport with the patient. Active listening and empathy with patients also improve rapport.

2. Medication review: The pharmacist shall collect medication history and prescriptions from the patients. The clinical pharmacist shall review the medication order and inform the followings to the patients:

   • Drug name: Generic name/trade name.

   • Purpose of medication,

   • Drug administration: Route of drug administration is slightly confusing for the patients. A tablet can be administered in nine different ways such as to place on the tongue and swallowed, chew and swallow, not to be chewed, allow to dissolve in mouth and suck it, sublingual tablet not to be swallowed, dissolve in water and swallow, dissolve in water and for external use only, moist with water and insert in vagina/rectum., etc. way to administer ophthalmic preparation, inhalation dosage form etc. The pharmacist shall educate patients about the route of administration of prescribed drugs.

   • Dose timing: The pharmacist shall interpret the medical practitioner’s direction regarding the dosing schedule. Whether the drug shall be administered on an empty stomach or after the meal depends upon the factors that affect the absorption and effectiveness of the drug.

   • Duration of therapy: The nature of the illness decides the duration of therapy. As a chronic disease requires long-term therapy. As the duration of therapy increases, complications of therapy shall also increase. Patients shall be advised to take the medicines regularly and consult a physician if any complication arises.

   • Side effects/Adverse effects: Each drug has side effects. Patients shall be informed about these effects and convinced not to worry. If it persists contact the prescriber or clinical pharmacists shall advise to manage side effects. Such as the use of metronidazole may cause a headache. Advise the patient to take paracetamol/aspirin if a headache appears. Do not drive or operate machines after consumption of drugs causing drowsiness.

   • Drug interaction: Prescribed drugs may interact with food, alcohol, tobacco or non-prescription drugs. Patients shall be warned about this drug interaction and to avoid these during therapy.

   • Allergy: The pharmacists shall enquire about the patient's medication history and drug-induced allergies. Accordingly, clinical pharmacists shall advise the consumption of medicines.

   • The pharmacist shall emphasize the importance of adherence to the medication order. Any query from the patient shall also be answered.

3. Instruction on medication use:

   • Drug packaging: Drug packaging may be slightly confusing for the patient. Clinical pharmacists demonstrate the removal of the drug from the packaging of drugs, handling of eye drop containers, removal of dust caps from suppositories, use of inhalers etc.

   • Storage: The safety and efficacy of drugs depend upon their storage conditions. The patient shall be advised to store the drugs as per the storage conditions mentioned on the label of the drug. Such as at room temperature, in a cool place, in a refrigerator etc.

   • Explain the importance of the right dose at the right time for the recommended duration and action taken by the patient in case of a missed dose.

   • Prescription refill instruction.

4. Health education: The pharmacists shall access the understanding of their health condition and provide additional information to enhance their knowledge. The patient shall be educated about lifestyle modification, including diet, exercise, smoking cessation, etc. The importance of regular follow-up appointments with healthcare providers shall also be informed to the patients.

5. Address patient concerns: Patients shall be encouraged to ask questions and address any concerns about the medication and health conditions. Clarify the misconception or doubts related to treatment. Provide reassurance and support to alleviate anxiety and fear associated with medication use.

6. Documentation and follow-up: Documents of the counselling session including topics discussed, patient-specific instruction, and any additional information provided. Provide the patients with written materials. Or medication information leaflets for future reference. Schedule follow-up appointments or recommended contacting the pharmacists or healthcare providers if the patient has a future question or experiences any issues.

Pharmacy Council of India Pharmacy Practice Regulation Notification 2015 also states the above points to be included in patient counselling by pharmacists. 

Patient counselling should be tailored as per individual needs, health conditions, literacy, cultural background and religion, Pharmacist shall ensure confidentiality, respect patient autonomy, and maintain a patient-centred approach throughout the patient counselling session.