(C) Sir Clairol Pascua

2.  After completing the chapter, the students should be
able to:
1. Describe the potential benefits of patient counseling
to the patient.
2. Describe the potential benefits of patient counseling
to the pharmacists.
3. Discuss how patient counseling may be seen as a
service to the public and private and government
insurers.
4. Describe how patient counseling fits in with the
pharmaceutical care model.
5. Discuss the challenges faced by pharmacists in
patient counseling.

3.  The PPAC developed in 1998 by the
American Pharmaceutical Association
describes pharmacists’ activities.
1. Interviewing the patient
2. Obtaining patient information
3. Educating the patient
4. Providing verbal and written information
5. Discussing & Demonstrating
6. Face-to-face patient contact
7. Patient counseling

4.  In the practice of philosophy of
pharmaceutical care, pharmacists are
responsible directly to the patients they
serve.
 Patient counseling improves patient care.
 It is integral to providing competitive and
professional pharmacy services.
 Patient counseling and patient-pharmacist
interaction are key to the pharmacist’s role
today.

5.  Improve the quality of life and provide
quality care for patients.
 “Drug misadventures” and nonadherence
to treatment programs reduce quality of life
and interfere with quality care.
 In addition, the high costs of health care
today call for interventions to minimize
waste and to maximize benefits of medical
treatments.

6.  Nonadherence may result in prolonging
or increasing the severity of an illness.
 Lack of information about drugs is one of
the four most significant variables that
have the most bearing on reasons why
the elderly may fail to comply with their
medication regimens.
 Many studies have demonstrated the
effectiveness of pharmacist provision of
information and reminders.

7.  In addition to nonadherence and ADR,
through patient counseling pharmacists
can bring to light many other drug-
related problems such as:
1. Untreated indications
2. Improper drug selection
3. subtherapeutic dosage
4. Overdosage
5. Drug interactions, and
6. Drug use without indications

8.  It has recently been acknowledged by the
health care community that advents caused
by errors in patient care and treatment are
huge problems contributing to prolonged
hospital stays, increased illness and suffering,
and loss of confidence in the health care
system.
 Systems analysis of medication errors conclude
that contributing factors are multifactorial and
involve immediate causes stemming from
situational factors at the time the drug is
provided to the patient, while others involve
latent conditions related to the drug provision
system from manufacture and regulatory
systems to the patient.

9.  Causes:
1. Failed communication
2. Lack of patient education
3. Incorrect drug administration
4. Dispensing processes and drug distribution
5. Knowledge level of pharmacist, patient
and prescriber
 Patient education has been identified by
the Institute for Safe Medication Practices
as the most important error-prevention
strategy.

10.  In addition to reducing drug-related
morbidity and its subsequent costs to the
individual and society, patient counseling
may benefit patients in number of other
ways concerning improved outcomes and
satisfaction with care.
 Quality of communication in history-taking
and during discussion of the management
plan has been found to improve emotional
health, symptom resolution, function,
physiologic measures.

11.  Patients find communication,
interpersonal sensitivity, and partnership
with their healthcare providers to
improve satisfaction; they are
consequently more likely to adhere to
medical advice and to recall medical
information provided.
 As with prescription counseling,
pharmacist counseling for
nonprescription medications can benefit
patients both medically and financially.

12.  Finally, patients may benefit from
counseling by pharmacists in non-
medication related situations.
 Pharmacists in ambulatory care are often
the first contact with the health care
system, and as such can coordinate
services for the patient and family, as well
as provide continuity of care.
 They are also ideally situated to provide
public health services such as smoking
cessation and weight loss counseling and
counseling on preventing or coping with
disease condition.

13. Patient Counseling to Improve Patient Care
1. Reduces errors in using medication
2.Reduces noncompliance
3. Reduces adverse drug reactions
4. Improve outcomes
5. Increases satisfaction with care
6. Assists with self-care
7. Can provide referral assistance with non-drug-related situations (e.e,
family planning and emotional problems)
8. Reduces health care costs to individual, government and society
9. Is an integral part of providing patient-centred pharmaceutical care

14.  Pharmacists have a professional obligation to counsel
patients for many reasons including legal, personal,
professional and economic.
 Pharmacists are striving to be recognized by patients
and other health professionals as important players in
the health care team, that is, the team’s experts in
the field of drugs.
 Standards of practice for the profession of Pharmacy
by the APA and other pharmacy organizations, as
well as guidelines for patient counseling by these
organizations, promote the role of pharmacists in
patient counseling.

15.  In general, pharmacists report that
counseling and patient education are the
greatest sources of job satisfaction, and
that they want to spend more time advising
and counseling.
 Patient counseling offers pharmacists a
chance to demonstrate professional
capabilities and to use the knowledge that
they have gained through many years of
study.
 Personal satisfaction of helping another
person, particularly in helping that person to
regain or maintain health.

16.  An additional personal benefit for
pharmacist’s involvement in patient
counseling involves job stress.
 Through discussion with the patient
during counseling, the pharmacist can
come to understand the patient’s
position and gain his or her cooperation,
ultimately reducing the level of stress for
both patient and pharmacist.

17.  From the economic and business points
of view, patient counseling can be seen
as an extra service with the potential to
entice customers.
 The growing competition in pharmacy
with preferred provider organizations,
mail-order, managed-care pharmacies,
and international pharmacies serves to
emphasize the economic need for
pharmacists to enhance the value of
personal contact with patients through
patient counseling.

18.  Since the institution of legislation
requiring counseling in many jurisdictions,
specific consulting services such as
smoking cessation, diabetic or asthma
counseling have become more
appropriate to promote as additional
services for a fee, particularly to
pharmaceutical and insurance
companies who recognize the
sometimes long-term cost-saving
benefits.

19. Providing Professional Pharmacy Services through Patient Counseling
1. Provides compliance with pharmacy legislations, standards, and
regulations
2. Affords legal protection, since pharmacists may be held accountable
for injury resulting from insufficient information provided to the patient.
3. Maintains professional status as part of primary care and health care
team
4. Increases job satisfaction and reduces stress
5. Is an added service to meet patient demand and aid in market
competition
6. Increases revenue through payment for counseling services and
reduces loss resulting from unfilled or un-refilled prescriptions
7. Is an integral part of providing pharmaceutical care.

20.  Pharmaceutical care – an integrated
patient-specific model of pharmacy
practice and assert that to deliver
pharmaceutical care the pharmacist
must see the patient, explain the
proposed relationship, discuss the various
choices, obtain information, and seek
cooperation, trust and permission.

21.  Each step in the pharmaceutical care process
requires patient-pharmacist interaction:
1. Establishing the pharmacist-patient relationship
2. Collecting and interpreting patient information
3. Listing and ranking drug-related problems
4. Determining desired pharmacotherapeutic
goals
5. Determining feasible alternatives
6. Selecting and individualizing the most
appropriate treatment regimen
7. Designing a drug-monitoring plan
8. Implementing the decisions about drug use
9. Designing a monitoring plan to achieve desired
therapeutic goals and following up to
determine the success of treatment.

22.  Consulting with the patient is the main source of
information necessary for the pharmacist to
provide pharmaceutical.
 The pharmacists is able to develop a working
relationship, to gather the necessary facts, and to
determine the patient’s needs and wishes.
 The patient is able to contribute to identifying
problems and can play a role in deciding desired
outcomes and goals, identifying solutions and
options, treatment regimens, and in developing an
individual plan.

23.  Through regular discussion with the
patient, the pharmacist can ensure that
the patient carries out the plan and that
the plan is successful from both the
pharmacist’s and patient’s point of view.
 Thus, patient counseling is an integral
part of pharmaceutical care.

24. Challenges to Providing Patient-Counseling Services
System challenges Lack of time
Lack of incentives – economic, regulatory
Workforce dynamics
Lack of quality measures and processes
Lack of culture of quality improvement and
accountability for patient outcomes
Lack of policy change (corporate, health care)
Regulations
Lack of acceptance by phycisians

25. Pharmacy environment Lack of privacy
Physical barriers
Inaccessibility of the pharmacist
Atmosphere conducive to communication
color, light, sound)
Patient challenges Patient’s poor perception of the pharmacist
Lack of awareness on the part of the patient
of the need for counseling and of its
availability
Comprehension difficulties
Lack of time
Lack of choice

26. Pharmacist challenges Lack of knowledge about drugs
and the patient’s history)
Lack of confidence
Lack of skills (problem solving,
interpersonal, counseling, self-
assessment)
Busyness and poor prioritization
and time management
Business skills
Lack of resources (software,
designated space)
Perception of the importance of
the patient’s need for the
information
Inability to disengage old practice
model
Lack of ability/knowledge to
change

27. The challenge of change Global practice reorientation
Internal and external changes
needed
Structural changes
Procedural changes
Role orientation
Change in organization culture