Unit 15

1. Effective Communication
with
Patients and Providers
(Including Skill Station Training Using Expert Patients)
Unit 15
HIV Care and ART: A Course for
Pharmacists by Salahadin M.Ali

2. 2
2
Unit Learning Objectives
 Describe the team approach to HIV care and
treatment
 Explain basic principles and behaviors of ART
counseling
 Describe essential steps in communicating with
a multidisciplinary team.
 Describe essential steps in communicating with
an HIV-positive patient
 Demonstrate effective communication with
patients and providers

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3
Team Approach in ART
 Involves pharmacist or druggist, and other
multidisciplinary team members working
together towards comprehensive patient care
 Involves information sharing between providers
and patients
 Ensures patient confidentiality
 May involve others (family members) as per the
patient’s choice.

4. 4
Objectives of Effective Communication
 Pharmacists need to be able to share
information in order to work effectively with
patients, and the multi-disciplinary team
members.
 On a professional level with the multidisciplinary team
 With an individual patient on a level that he/she can
understand

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5
Communicating with the Multi-
disciplinary Team Members
 Begin by identifying yourself
 Identify the patient you are to discuss
 Present the issue or concern that you have
identified
 Do not be judgmental
 Use professional rapport to gain respect
 Be prepared to discuss the issue at a
professional level
 Propose a solution
 Await feedback

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Communicating with the Multi-
disciplinary Team Members (2)
 You may not always have all of the answers to
the questions that follow
 Be comfortable saying that you do not know the
answer at the moment, that you will look into it
and get back to the provider as soon as you can
 The provider will respect that you provide only
information about which you are confident
 Over time, you will build a working relationship
with the multidisciplinary team members that you
work with

7. 7
Communicating with Patients – Importance
of Patient Counseling
 Effective patient counseling is not simply the
provision of information.
 Information is prerequisite to compliance but the
timing and organization of the message and
involvement of the patient are also critical in
determining what the patient understands and
remembers.

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8
Communicating with Patients –
Readiness for ART
 Assess readiness to start ART
 Identify barriers to success with ART such as:
• knowledge about ART
• fears of adverse effects
• stigma
• financial concerns
• sustainability
• non-adherence
 Work with the ART team to correct barriers
before starting therapy. Every patient has
unique barriers to success

9. 9
Communicating with Patients – Counseling
Checklist
 A patient counseling checklist (PCC-09) should
be used when counseling patients. Some of the
important counseling points are listed below:
 Name of drug
 Directions for use
 Common or severe adverse effects
 Significant drug interactions
 Storage
(Refer to the Participant Handbook to see the PCC, and the
separate job aid on counseling-Medicine Use Counseling
Guide)

10. 10
Communicating with Patients –
Providing Information
 If written information is provided, identify
whether the patient has any learning barriers
such as low literacy
 Use pictures to communicate information
 Indicate colors of the pills to familiarize
patients with their regimen
 Ensure written information is provided in
patient’s native language

11. 11
Communicating with Patients –
Providing Information (2)
 Ask patient to tell you how they will use the
medication
 Correct misunderstandings before they leave
 Give patients specific examples of how to
remember to take their doses: for example,
when they brush their teeth or when they wake
up their children
 Assist patients in preparing for changes in their
routine: for example, vacation or visiting family

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12
Communicating with Patients -
Adherence
 Review need for strict adherence
 Near-perfect adherence is necessary for treatment success.
 Prevents resistance and treatment failure, which may limit future
treatment options
 Assess adherence each time patients refill their ART
 Ask questions like "When did you last miss a dose?”
rather than, “Have you missed any doses?”
 Congratulate the adherent patient
 Identify the reason for missed doses and provide
possible solutions to avoid missing doses in the future

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13
Communicating with Patients – Clinical
and laboratory monitoring
 Review the need for ongoing clinical and
laboratory monitoring
 Success/failure of ART regimen
 Toxicities
• Detect ART adverse effects that the patient may not
feel
• Evaluate symptoms

14. 14
Role Plays with Patients (Expert Patient
Training-EPT) (1)
 The role plays on communicating with patients
uses Expert Patient Training.
 Expert patient training uses PLHIV who are
experts in their own illness in the training of
health workers.
 These PLHIV were trained to portray patients
based on specific HIV cases that were often but
not necessarily similar to their own life
experiences.

15. 15
Role Plays with Patients (Expert Patient
Training-EPT) (2)
 Use the 5 A’s when communicating with patients (and
also with the expert patient trainer) *:
 ASSESS
• Ask why patient came to the pharmacy
• Review the medications with the patient
• Determine whether there is an adherence problem
 ADVISE
• On prevention
• On correct treatment
• On adherence
• Provide counseling according to PCC-09
 *See the Participant Handbook for details on the 5 A’s.

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Role Plays with Patients (Expert Patient
Training-EPT) (3)
 AGREE
 On treatment plan
 Involve patient
 ASSIST
 Provide treatment options
 Help solve treatment problems
 Provide psychological support

17. 17
Role Plays with Patients (Expert Patient
Training-EPT) (4)
 ARRANGE
 Follow-up date(s)
 Provide treatment plan
 Complete PIS-04
 In addition to the 5 A’s the pharmacy
professional should remember the following
general points:
 Be respectful to the patient
 Use simple words
 Listen to patient
 Make sure the patient has understood all points

18. GALIDRA
•Greeting
•Ask
•Listen
•Identify
•Discuss
•Recommend
•Agree/Appoint

19. 19
Role Plays with Patients (Expert Patient
Training-EPT) – (5)
 Steps:
 Demonstration of a case by a facilitator trained on
EPT with the expert patient trainer. (30 minutes)
 Role plays of trainees with the expert patient trainer.
(13 cases)
• Session 1 (Cases 1-3, ART Initiation Cases) (2 hrs)
• Session 2 (4-13, ART Follow-Up Cases) (2 hrs)

20. Role Plays

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Role Play Scenario (1)
 A patient brings a prescription to the pharmacist
for stavudine + zidovudine + nevirapine
 Contact the patient’s physician to alert them to
the drug interaction between stavudine and
zidovudine and recommend an alternative
regimen

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Role Play Scenario (2)
 A patient comes to your pharmacy and through your
conversation with him you discover that he meets the
criteria for starting Cotrimoxazole preventive therapy
(CPT). He just completed treatment for PCP 2 weeks
ago. He is not currently taking Cotrimoxazole for CPT
 Ask the patient if he has had Cotrimoxazole in the past
and try to find out if he has any drug allergies. Then,
contact the patient’s nurse/physician to suggest that the
patient be started on Cotrimoxazole DS daily for CPT, if
appropriate

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Role Play Scenario (3)
 A patient comes to the pharmacy and tells you
that he has been feeling itchy. He pulls up his
shirt and shows you a rash on his skin
 You look at his medication profile and see that
he started the following regimen 3 weeks ago:
stavudine + lamivudine + nevirapine
 You have established that the patient has a mild
rash
 Contact the patient’s nurse or physician and
pass on the information about the Nevirapine
drug reaction

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Role Play Scenario (4)
 A patient comes to your pharmacy with
prescriptions for:
Lopinavir/ritonavir, Stavudine, Lamivudine
Rifampin, Isoniazid & Pyridoxine, Pyrazinamide, Ethambutol
 You remember the drug interaction between
Lopinavir/ritonavir and Rifampin and recognize that
these two drugs should not be combined together
 Contact the patient’s physician/nurse with this
information. Recommend an alternative regimen (or
beginning ART after TB 2-month initiation)

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Role Play Scenarios 5-17
 These role plays use the expert patient training
(EPT) cases.
 See the separate EPT Amharic version cases
(Cases 1-13)

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Key Points
 A team approach to HIV care and treatment is an
effective way to care for HIV-positive patients
 Good communication with providers and patients
is essential for successful HIV care and
treatment
 Pharmacists need to counsel patients on ART
readiness, ART information, and the importance
of adherence and ongoing monitoring
 Use the principle of 5 A’s when communicating
with patients