Patient counseling

1. 1
Definition
Patient counseling is defined as providing medication information orally or in written form to
the patients or their representatives on directions of use, advice on side effects, precautions,
storage, diet and life style modifications.
Objectives
1. Patient should recognize the importance of medication for his wellbeing.
2. A working relationship and a foundation for continuous interaction and consultation should
be established.
3. Patient’s understanding of strategies to deal with medication side effects and drug
interactions should be improved.
4. Should ensure better patient compliance.
5. Patient becomes an informed, efficient and active participant in disease treatment and self-
care management.
6. The pharmacist should be perceived as a professional who offers pharmaceutical care.
7. Drug interactions and adverse drug reactions should be prevented.
Patient counseling consists of four stages:
1. Preparing for the session
2. Opening the session
3. Counselling content
4. Closing the session
Preparing for the session
The success of counseling depends on the knowledge and skill of the counselor. The
pharmacists should know as much as possible about the patient and his/her treatment details.
If the patient is receiving a medication which is unfamiliar to the pharmacist, then a drug
information reference should be consulted before counseling commences.
Review the patient's record
* Introduce yourself.
* Explain purpose of counseling.
* 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.

2. 2
Opening the session
The first phase of counseling is used for information gathering. The pharmacist should
introduce him or herself to the patient and greet them by name. It is the beat to use titles such
as Ms, Mrs. and Mr. and then switch over to the first name. The pharmacist should identify
the purpose the session very clearly. For example, “Hello Mr. Sreenivas! I am Arghya, your
pharmacist. I would like to tell you about your medication. Do you have a few minutes to
spend with me?” Patient may be disturbed and distressed due to their illness, a few kind
words to demonstrate empathy and understand in will assist the counseling process. During
counseling, the pharmacist should avoid asking question in a direct or embarrassing way,
show excessive curiosity, discuss the patient’s personal problems, pass moral judgments,
interrupt when the patient is speaking, make premature interpretations or argue with the
patient.
Counselling content
The counseling content is considered to be the heart of the counseling session. During this
stage the pharmacist explains to the patient about his or her medications and the treatment
regimen. Topics commonly covered include:
•Name and strength of the medication.
•The reason why it have been prescribed (if known), or how it works.
•How to take the medication.
•Expected duration of the treatment.
•Expected benefits of the treatment.
•Possible adverse effects.
•Possible medications or dietary interactions.
•Advice on correct stage.
•Minimum duration required to Show therapeutic benefit.
•What to do if a dose is missed.
•Special monitoring requirements, for example, blood tests.
Closing the session
Before closing the session, it is essential to check the patient’s understating. This can be
assessed by feedback questions, such as “Can you remember what this medication is for?” or
“for how long should you take this medication?” during the discussion some of the patient’s
information needs may have been cleared, but the patient may have new questions or doubts.
Before final closure and if time permits, summarize the main pints in a logical order. If
appropriate, the pharmacist can supply their telephone number to encourage the patient to
make contact if they need advice or information.

3. 3
Issues regarding manner
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.
Patients who should always be counseled
- Confused patients, and their caregivers
- Patients who are sight or hearing impaired
- Patients with poor literacy
- Patients whose profile shows a change in medications or dosing
- New patients, or those receiving a medication for the first time (transfer prescription)
- Children, and parents receiving medication
- Patients receiving medication with special storage requirements, complicated directions,
Patients who should be counseled at certain intervals
- Asthmatic patients
- Diabetic patients
- Patients taking 4 or more prescribed medications
- Patients who are mentally ill
- Patients using appliances
- Epileptic patients
- Patients with skin complaints
- Patients misusing drugs
- Patients who are terminally ill
Counseling area
The patient should be counseled in a semiprivate, or private, area away from other people and
distractions, depending on the medication(s). The patient should perceive the counseling area
as confidential, secure and conducive to learning. This helps ensure both parties are focused
on the discussion, and minimizes interruptions and distractions. It provides an opportunity for
patients to ask questions they may be hesitant to ask in public.

4. 4
Patient Compliance
Patient compliance describes the degree to which a patient correctly follows medical advice.
Most commonly, it refers to medication or drug compliance, but it can also apply to other
situations such as medical device use, self-care, self-directed exercises, or therapy sessions.
When is adherence important
 Replacement therapy – insulin, thyroxine
 Maintenance of pharmacological effect – antihypertensive drugs
 Maintenance of serum drug concentration to control a particular disorder –
anticonvulsants
 To control diseases of public health – HIV, TB
 In chronic diseases
 Contraceptive pills
 Overdose which causes serious health hazards
Barriers to patient compliance
Health literacy
Cost and poor understanding of the directions for the treatment, referred to as health literacy
have been known to be major barriers to treatment adherence. There is robust evidence that
education and physical health are correlated. Poor educational attainment is a key factor in
the cycle of health inequalities.
Treatment cost
Highest prices of prescription drugs mainly attributed to the government's lack of negotiating
lower prices with monopolies in the pharmaceutical industry especially with brand name
drugs. In order to manage medication costs, many patients on long term therapies fail to fill
their prescription, skip or reduce doses.
Age
Both young and elderly status have been associated with non-adherence. Elderly individuals
may face challenges, including multiple medications with frequent dosing, and potentially
decreased dexterity or cognitive functioning.
Prescription fill rates
Not all patients will fill the prescription at a pharmacy. Factors are doubting the need for
medication, or preference for self-care measures other than medication. Convenience, side
effects and lack of demonstrated benefit are also factors.
Social factors
 Young people who felt supported by their family and doctor, and had good motivation,
were more likely to comply.
 Young adults may stop taking their medication in order to fit in with their friends, or
because they lack insight of their illness.
 Those who did not feel their condition to be a threat to their social well-being were eight
times more likely to comply than those who perceived it as such a threat.

5. 5
 Non-adherence is often encountered among children and young adults; young males are
relatively poor at adherence.
The World Health Organization (WHO) groups barriers to medication
adherence into five categories
Barrier Category
Poor Patient-provider Relationship Health Care Team and System
Inadequate Access to Health Services Health Care Team and System
High Medication Cost Social and Economic
Cultural Beliefs Social and Economic
Level of Symptom Severity Condition
Availability of Effective Treatments Condition
Immediacy of Beneficial Effects Therapy
Side Effects Therapy
Stigma Surrounding Disease Patient
Inadequate Knowledge of Treatment Patient

6. 6
Detection and improvement of compliance
 To track the record weather the patient is following the prescribed medications or not: for
this electronic access to patient prescription and refill records is checked.
 By using electronic questionnaire system in which the patient is asked about the current
drug treatment and relief after starting the treatment.
 By appointing nurse case managers which checks the patience adherence and non-
compliance at a very personal level.
 Utilizing pharmacist as a tool to resolve noncompliance.
 Long, complex and redundancy of drug regimens also lead to non-compliance so; this
point should also be taken care in mind while prescribing the medication.
 By the use of generic drugs which are more cost effective as that of branded drugs
 In a country like India, where it has been estimated that the per capita income of the
weaker class is about Rs. 32per person per day, we cannot expect that person or family to
buy medicines which costs in hundreds or thousands. So for that reason such families or
person should be subsidized for medical procedures and purchases.
Role of pharmacist in patient compliance
 The role of the pharmacist has widens and it also include identifying drug-related issues
and providing patient consultations regarding drug therapy.
 Medication information should be provided to patients during the counseling session.
This information includes, the common and severe adverse effects, drug interactions and
contraindications and appropriate direction of use by the patient.
 The role of the pharmacists is to warn the patients of the side effects of a drug.
 Pharmacists are engaged in counseling the patient at the time of dispensing medications.
Pharmacists can contribute to patients' safety by advising them of the risks posed by
certain medications.
 Before counseling the pharmacist should review the patient's prescription and
nonprescription drug history. The medication review must include an assessment of any
increase in side effects from any individual drug or drug combinations. Patients are
generally unaware of the risks of being involved in over-the-counter preparations or of
the potential additive effects of the drugs.
Conclusion
 Patient compliance is a complex issue leading to huge burden on healthcare system and
needs immediate attention from patient, pharmacist and physician.
 Compliance aids and technologies also play important role in patient compliance. By
providing a simplistic overview of methods for enhancing compliance so that the research
can be translated and applied to patient care Involving healthcare providers, in addition to
physicians in order to reduce the time and cost involved in implementing these strategies.