The availability of and rational use of medicines are critical for a successful therapeutic outcome. Though rapid developments in science and technology have led to easy understanding of etiology and pathophysiological basis of various diseases and development of new molecules, many times clinicians fail to achieve the desired therapeutic goals. One of the major reasons for this can be the patient non-compliance or partial compliance towards the prescribed treatment (World Health Organization, 2003). Patient compliance is defined as the adherence of a patient towards the prescriber‘s instructions. It implies an understanding of how the medicine is to be used, as well as a positive behavior in which the patient is motivated sufficiently to use the prescribed treatment in the manner intended because of a perceived self-benefit and a positive outcome (e.g. enhanced quality of life and well being).

1. PATIENT COUNSELING
By
Biswanath prusty
Assistant professor

2. INTRODUCTION
❖ The availability of and rational use of medicines are critical for a successful therapeutic outcome.
Though rapid developments in science and technology have led to easy understanding of etiology
and pathophysiological basis of various diseases and development of new molecules, many times
clinicians fail to achieve the desired therapeutic goals. One of the major reasons for this can be the
patient non-compliance or partial compliance towards the prescribed treatment (World Health
Organization, 2003). Patient compliance is defined as the adherence of a patient towards the
prescriber‘s instructions.
❖ It implies an understanding of how the medicine is to be used, as well as a positive behavior in
which the patient is motivated sufficiently to use the prescribed treatment in the manner intended
because of a perceived self-benefit and a positive outcome (e.g. enhanced quality of life and well
being).
❖ Non- compliance can lead to various consequences including underuse, overuse, misuse, abuse etc.
The most common factors associated with noncompliance are the nature of the disease, multiple
drug therapy, frequency of drug administration, duration of drug therapy, adverse events, cost of
medications, administration technique, taste of medication etc. In the present days, the term
―concordance is used more often in place of ―compliance.

3. ❖Safe and effective drug therapy depends on patient being well informed about
their medication. Health Care is provided in India at primary, secondary, tertiary
Health Care level and at each level most patients receive medication as part of
their treatment due to heavy patient load , many prescribers have little time to
explain the proper use of medication to their patient .
❖The goal of all communication is proper understanding . Patient counselling is
the guidance provided to the patient by the pharmacists about the right use of
medicines. It is instructing the patient about various aspects of medicines like
route of administration, duration of drug, contraindications, precautions, common
side effects, storage and disease conditions.
❖Patient counselling is one of the major duty of a pharmacists other than
dispensing of drug.

4. PATIENT COUNSELING
❑ Patient counseling may be defined as providing medication information orally or in written form to
the patients or their representative or providing proper directions of use, advice on side effects,
storage, diet and life style modifications. It involves a one-to-one interaction between a pharmacist
and a patient and/or a care giver. It is interactive in nature. The effective counseling should
encompass all the parameters to make the patient/party understand his/her disease, medications and
life style modification required.
Definition –
Patient counselling refers to the process of providing information advice and assistance to help patient
use there medication appropriately. The information and advice is given by the pharmacist directly to
the patient or to the patient’s representative and may also include information about the patient’s illness
or recommended lifestyle changes .The information is usually given verbally , but may be
supplemented with written material.

5. Aim & Objectives of patient counselling-
➢ Patient should recognize the importance of medication for his well-being.
➢ A working relationship for continuous interaction and consultation should be established.
➢ Patient understanding of strategies to deal with medication side effects and drug interactions
should be improved.
➢ 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.
➢ Drug interactions and adverse drug reactions should be prevented.
➢ Potential for decreased health care costs due to appropriate use of medications and prevention of
adverse effects.
➢ Better patient understanding of their illness and the role of medication in its treatment.
➢ Improved medication adherence.
➢ More effective drug treatment.
➢ Reduced incidence of medication errors, adverse effects and unnecessary healthcare costs.
➢ Improved quality of life of the patients.
➢ Better coping strategies for medication-related adverse effects.
➢ Improved professional rapport between the patient and pharmacist.

6. Potential benefits to patients:-
Improved therapeutic outcomes and decreased adverse effects.
Improved patient adherence to the treatment plan.
Decreased medication errors and misuse.
Enhanced patient self-management by involving the patient in designing the therapeutic plan.
Potential for decreased health care costs due to appropriate use of medications and prevention of adverse events.
Potential benefits to Pharmacists:-
Enhanced professional status in the view of patients and other health care providers.
Establishment of an essential component of patient care that cannot be replaced by technicians or automation.
Enhanced job satisfaction through improving patient outcomes.
A value-added service to offer patients.
Revenue generation through payment for counseling services– limited at present but growing.
It is expected that, as a result of a properly conducted counseling interaction, the patient will:
Recognize why a prescribed medication is helpful for maintaining or promoting well-being
Accept the support from the health care professional in establishing a working relationship and foundation for
continual interaction and consultation
Develop the ability to make more appropriate medication-related decisions concerning compliance or adherence
Improve coping strategies to deal with medication side effects and drug interactions
Become a more informed, efficient, active participant in disease treatment and self-care management
Show motivation toward taking medications to improve his or her health status.

7. Counselling
Skills of counselor
Stages of counselling
Approaches of counseling
Change cycle
Barriers of counselling

8. Key skills of counsellor
Listening
Believing in client
Recognize your own limitations
Patience
Non-judgemental
Stay focused
Knowledgeable

9. Communication Skills for Effective Counselling
The counselling process uses verbal and non-verbal communication skills.
▪ Verbal communication:- Verbal communication skills include language and
paralinguistic features such as tone, volume, pitch and rate of speech.
Paralinguistics, or the way we say words, accounts for 40% of how a message is
received, so the way in which we speak has an impact on patient understanding.
1. Language : When speaking to patients, use simple language and avoid
unnecessary medical terminology. If possible, speak the patient’s own language.
2. Tone : During counselling, the tone of our voice has a great impact on patient
understanding. Changes in the level and range of pitch convey information
about the feelings and attitudes of the person speaking. When counselling, the
tone of the voice should be caring and reassuring.
3. Volume : Many people speak with wide variations in volume, depending on the
situation, and where and to whom they are speaking. Ideally, counselling should
be conducted in a quiet, private setting where it is unnecessary to raise one’s
voice.
4. Speed : The clarity of our communication depends on our rate of speech.

10. Non-verbal communication : This includes body language such as the movement and
position of the head, limbs and body, and other aspects such as whether the pharmacist is
dressed in a professional manner. During any interaction, approximately 50% of the way a
message is conveyed comes from body language. Aspects of non-verbal communication
include proximity, touch, eye contact, facial expressions, head movements, gestures with
hands and arms and body postures.
1. Proximity : This refers to the distance that people maintain between themselves during
the counselling process. This space has been classified into four zones: intimate (45 cm
or less), personal (45 cm to 1.2 m), social (1.2–3.6 m) and public (>3.6 m). Generally,
counsellors and healthcare professionals use intimate or personal proximities.
2. Eye contact : The amount that people look at one another during conversation varies
depending on whether they are speaking or listening. Listeners look at the speaker more
often and for longer periods of time. For cultural or personal reasons such as timidity,
sadness or depression, some people may avoid looking into the counsellor’s eyes.
3. Facial expression : These can be used during counselling to demonstrate empathy
towards the patient. Head movements such as nodding, hand gestures and body posture
also can be used to advantage.

11. 1.Listen Actively
2.Questioning
3.Using silence
4.Non-verbalbehavior
5.Accurate Empathy
6.Paraphrasing
6 Micro skills of counsellor

12. 1.Listen Actively
• Accept the clients as they are.
• Listen to what your client say and how
they say it. Notice the tone of the
• voice ,facial expression and gesture.
• Keep silent sometimes. Give your
client to think ,ask question.
• Sit comfortably.
• Look directly into the client when
they speak ,not on your papers and
windows.
• Ensure that you are continually
involved in the conversation by either
“nodding head, saying then or oh”.
• According to communication expert:
• 10 % of our communication
represented by words.
• 30 % are represented by sounds we
make (by minimum verbal).
• 60 % are represented by body language
(e.g.-
‐
-eye contact , body posture etc.)

13. 2. Questioning
• Ask the question to understand
clearly the client problem or worries
to help the client go deeper into
his/her own awareness or insight.
Question centered around the concerns
of client and open ended.
At the time of asking question: Remember
▪
▪ Ask one question at a time.
▪
▪ Look at one person.
▪
▪ Be brief and clear.
▪
▪ Ask question that serve for purpose.
▪
▪ Use question that enables clients to talk
about their feelings and behaviors.
▪
▪ Use question to explore and understand
issues.
Don’t ask
▪
▪ Irrelevant question.
▪
▪ Too many question at one time.

14. • Give time to the client to think about
what to say next.
• Provide space to experience felling.
• Allow client to proceed at their own
pace.
• Give the client freedom to choose
whether or not to continue.
• Counselling should be done in a quiet
room.
3.Using silence 4. Non-verbal behavior
• It is not what you say but how you
say is important.
• Majority-non verbal.
• Person body language is not similar to
what they are saying, it results in
verbal confusion/ Misinterpretation.
• Effective counsellor-sensitive to
nonverbal communication.
• Examples- gestures, facial expression,
posture, eye contact, tapping fingers,
change in voice pitch and fluency of
voice.

15. 5. Accurate Empathy
• Empathy means recognition and understanding of clients thoughts
and emotions.
• It is characterized by ability to put oneself into another's shoes i.e.
experience the view point of another within oneself.
6. Paraphrasing
•Counsellor repeat in his/her own words
what client has said to show understanding.
• Say in few words so that it can give summary of client’s word.
Sympathy is feeling
compassion, sorrow, or pity for
the hardships that another
person encounters,
while Empathy is putting
yourself in the shoes of
another.

16. Stages of Counselling GATHER
Greet client in a friendly, helpful, and respectful manner.
Ask client about needs, concerns, and previous use.
Explain to client how to use the method.
Return: Schedule and carry out return visit and follow-up of client
G
A
T Tell client about different options and methods.
H Help client to make decision about choice of method s/he prefers.
E
R

17. Greet
• Welcome and register client.
• Prepare chart/record.
• Determine purpose of visit.
• Give clients full attention.
• Assure the client that all information discussed will be confidential.
• Talk in a private place if possible.
G

18. Ask
• Ask client about her/his needs.
• Write down the client's: age, marital status, number of previous pregnancies and
births, number of living children, basic medical history, previous use of family
planning methods, history and risk for STDs.
• Assess what the client knows about family planning methods.
• Ask the client if there is a particular method s/he is interested in.
• Discuss any client concerns about risks vs. benefits of modern methods (dispel
rumors and misconceptions).
A

19. Tell
• Tell the client about the available methods.
•Focus on methods that most interest the client, but briefly mention
other available methods.
•Describe how each method works, the advantages, benefits,
possible side effects, and disadvantages.
• Answer client concerns and questions
T

20. Help
•Help the client to choose a
method.
•Repeat information if
necessary.
•Explain any procedures or lab
tests to be performed.
Explain
•Explain how to use the method
(how, when, where).
•Explain to the client how and
when s/he can/should get
resupplies of the method, if
necessary.
H
E

21. Return
• At the Follow-up or return visit ask the client if s/he is still using the
method.
• If the answer is yes, ask her/him if s/he is experiencing any problems or
side effects and answer her/his questions, solve any problems, if possible.
• If the answer is no, ask why s/he stopped using the method and counsel
her/him to see if s/he would like to try another method or re-trythe same
method again.
• Make sure s/he is using the method correctly (ask her/him how s/he is
using it).
R

22. Counselling and health education
Counselling Health education
Confidential Not confidential
One to one process or a small
group.(e.g. a group of obese pts)
For a group of people
Focused, specific and goal directed Generalized
Facilitates change in attitude and
motivates behavior change
Information is provided to increase the
knowledge
Problem oriented Content oriented
Based on needs of client Based on public health needs

23. Counselling content: The counselling content is considered to be the heart of the counselling session.
During this step, the pharmacist explains to the patient about his or her medications and treatment
regimen. Lifestyle changes such as diet or exercise may also be discussed. Topics commonly covered
include:
➢ Name and strength of the medication
➢ The reason why it has been prescribed (if known), or how it works
➢ How to take the medication (how much and how often)
➢ Expected duration of treatment
➢ Expected benefits of treatment
➢ Possible adverse effects
➢ Possible medication or dietary interactions
➢ Advice on correct storage
➢ Minimum duration required to show therapeutic benefit
➢ What to do if a dose is missed
➢ Special monitoring requirements, for example, blood tests
➢ Arrangements for obtaining further supplies

24. Approaches in doing counselling
1.Directive or Counsellor
centered or authoritarian style:-
• Simplest to do.
• Counsellor give advices, make decision
based on what she thinks is in the best
interest of client.
• Expects the client to follow her advices.
• Completely directed by counsellor.
2. Non-directive counselling or
client centered :-
• Counsellor is passive mainly listener.
• Client is active ,expresses herself freely
and tells the counsellor what he/she
wants.
• After careful reflection and clarification ,
makes her own decision.
• The main function of the counsellor is to
create an atmosphere in which the client
can work out his problem.
• Commonly used by social workers and
psychologists.

25. Approaches in doing counselling
3.Non-authoritarian style:-
• Neither counsellor nor client
controlled.
• Methods of counselling may change
from client to client or even with the
same client from time to time.
• It is highly flexible.
• Freedom of choice and expression is
open to both the counsellor and the
counselee.

26. Cycle of changes

27. Barriers to Counseling in Clinical Practice
Personal Barriers
Lack of training:
undergraduate/
postgraduate
Undervaluing
importance of
communication
Focus only on
treating diseases
Personal
Limitations
Organizational
Barriers
Lack of time Pressure of work
Interruptions

28. Strategies to overcome barriers:
To overcome the patient based
barriers , following strategies can be
implemented.
• Using multi media materials
• Pictograms
• Oral and written information
• Compliance aids
• Follow up schedules
• Audio visual tapes
• Tailoring prescription instructions.
Patients who should always be counselled-
1. Confused patients and their care givers .
2. Patients who are sight or hearing impaired.
3. Patients with poor literacy .
4. Patients whose profile shows a change in medications.
5. Patients receiving medication with special storage
requirements, complicated direction.
6. Children and parents receiving medication.
7. New patients, or those receiving a medication for the first
time ( transfer prescription).
Patients who should be counselled at certain intervals:
1. Prescription , monitoring , aim to maximize drug efficiency ,
minimize drug toxicity and promote cost effectiveness.
2. Therapeutic drug monitoring of drug with narrow
therapeutic index.
3. Drug information service
4. Patient service
5. Improving patient compliance collecting past medical
history.

29. Conclusion
• Counselling is a process and not
merely a technique through which
clients are helped to modify their
behavior and cope with their status
effectively.
• Counselling is NOT
• Telling or directing
• Giving advice
• A casual concern
• A confession
• Praying