The document discusses patient counseling in pharmacy from educational and counseling perspectives. It defines counseling, consulting, and education and differentiates the terms. Various counseling theories and models of patient-provider relationships are described. The document emphasizes that patient counseling involves both counseling and education, drawing from different theories depending on the situation and patient needs. The goals of patient counseling are to establish trust and help patients manage their medication and health, while educational goals involve providing tailored information to meet patient needs. An andragogical approach is recommended to align counseling with adult learning principles and make it most effective.

2.  After completing the chapter, the students should be able
to:
1. Differentiate between the terms patient counseling,
consulting, and patient education.
2. List the counseling and education goals of patient
counseling in pharmacy
3. Describe the differences between the various models of
patient-provider relationships.
4. Describe the adult educational approach of andragogy
as applied to patient counseling
5. Define patient counseling in pharmacy.

3.  Counsel – giving advice, but it also implies
mutual discussion and an exchange of
opinions.
 Consult – to seek advice, and suggests
almost exclusively receiving advice rather
than exchanging information.
 Education – involves a slightly different
sphere of interaction. It is defined as
“instruction and development to impart
skills and knowledge”

4.  The theories underpinning the professional
fields of counseling and education offer
more comprehensive explanations of these
terms.
 Listening – psychotherapy
 Questioning
 Evaluating
 Interpreting counseling
 Supporting
 Explaining
 Informing
 Advising
 Ordering

5.  In educational theory, education connotes
much more than simply imparting
knowledge.
 It may defined as “progressive changes of
a person affecting knowledge, attitudes,
and behavior as a result of instruction and
study.”
 Education involves processes through which
people develop their abilities, and enrich
their knowledge, and which help bring
about changes in their attitudes and
behavior.

6.  Form this semantic discussion, it may be
seen that the activity that pharmacists
refer to as “patient counseling” involves
counseling in the psychological sense, as
well as activities that aim to educate
patients.
 It encompasses theories of counseling
and educating in varying degrees,
depending on the situation and the
needs of the patient.

7. BEHAVIORAL THEORY
 B.F. Skinner – suggested that behavior that is reinforced is
repeated and, conversely, behavior that is not reinforced
or that is actually punished is not repeated.
 A broader approach is cognitive behavior modification. It
assumes that it is not the experience alone that is the
cause of behavior, it is the individual’s underlying
cognition of the experience (conceptions. Ideas,
meanings, beliefs, thoughts, inferences, expectations,
predictions, or attributions)
 Vary from individual to individual and are acquired
throughout the course of life through experiences.

8.  When explaining to the patient the reasons
behind medication instructions and the ways in
which the medication will treat the condition,
the pharmacist attempts to change the
patient’s thoughts about the usefulness of the
medication, and the importance of
adherence.
 This change in the patient’s thoughts is
expected to result in a behavioral change with
regard to taking medication.
 Behavior therapy is the source of the patient
education methods, such as self-monitoring,
demonstration (modeling), and practice
(behavior rehearsal)

9. THEORIES OF HEALTH BEHAVIOR
 There have been attempts to analyze why patients
behave the way they do when they are ill and need to
take medication.
 It suggests that patient’s perceptions about the severity
and possible outcomes of their conditions, the
effectiveness and benefits of medication use, and various
triggers to taking medication may be critical elements in
patient medication use.
 These theories indicate that patient counseling involves
not only an exchange of information, but should also
involve an attempt to change the patient’s health beliefs.

10. HUMANIST APPROACHES TO COUNSELING
 The humanist school of psychology considers people’s
thought and feelings in addition to behaviors.
 When pharmacists counsel patients they should
acknowledge that patients are not only behaving due to
external controls of stimulus and reward, but also thinking
and feeling.
 Pharmacists’ counseling should take the patient’s feelings
and thoughts into consideration.
 The person-centered approach to counseling, by Carl
Rogers, is part of humanistic psychology and is one of the
greatest influences on the field of counseling.

11.  This approach to counseling is based on the idea that
people will naturally grow and develop their capacities
(self-actualization)
 From this perspective, the pharmacist helps patients get
the most benefit from their therapy by helping them feel
capable of controlling their own medication use – by
helping them identify and solve their own problems in this
area. This echoes the concepts in pharmaceutical care of
patient-centered care.
 A key element of Carl Roger’s patient-centered helping
approach is the pharmacist’s genuine feelings of warmth
and concern for patients and his or her trust in their abilities
to solve their own problems.
 This is exemplified in part by the pharmacist spending the
necessary time with each patient and by the pharmacist’s
helping attitude during the interaction

12. AN ECLECTIC COUNSELING THEORY
 Gerard Egan – Process of helping. The aim of counseling is
to help people manage their problems more effectively.
 The process of helping described by Egan involves three
stages:
1. Clarifying the problem (to explore the individual’s
viewpoint of the problem)
2. Setting goals (achieving an overview of the individual’s
problems and setting goals to overcome them)
3. Facilitating action (to help the person plan ways of
achieving the goals set, to carry out the goals, and to
evaluate the outcomes).

13. TREATMENT DECISION-MAKING MODELS
MODEL TYPE CHARACTERISTICS
PATERNALISTIC •Assumes doctor knows best
•Doctor selects treatment
•Patient involvement limited to giving consent
•No consideration of patients’ values or preferences
INFORMED DECISION
MAKING
•Patient alone will make decision when provided with all
necessary technical information
•Clinician’s role is to provide information to support patient
in decision
PROFESSIONAL-AS-
AGENT
•Assumes only doctor has sufficient technical knowledge
to make final decision
•Recognizes importance of incorporated patient’s
preferences
•Final decision made by clinician
SHARED DECISION
MAKING
•Patient and clinician engage in the decision-making
process
•Information and values are shared
•Uses physician’s technical knowledge and experience
and patient’s experience, culture, and prefrences.

14.  In terms of pharmacist’s relationship with
patients, the pharmacist may be in a
decision-making position when discussing
self-medication.
 But in the case of prescribed medication,
the pharmacist is more in a position of
mediating the relationship between
physician and patient.
 Pharmacists are in an ideal position to assist
the patient and physician to share
information and common understanding.

15.  Counseling is essentially a helping process.
 The mission of pharmacy practice is to help people
make the best use of medications.
 Patient medication counseling – pharmacists talking
with patient about the medications they are
intended to take in order to educate them about
medication-related issues and to help them get the
most benefit from their medications.
 Helping and education goals

16.  Pharmacist must first establish a
relationship with the patient and
develop trust.
 The pharmacist must also demonstrate
concern and care for the patient in
order for him to know that the
information the pharmacist is providing
and the questions the pharmacist is
asking are in the patient’s interest.

17.  The essence of all counseling is to help a person
cope effectively with an important problem or
concern.
 Problem involves the individual’s health and the need
to fit medication use into his or her daily life.
 Patient counseling might also involve helping the
patient cope with illness and with the changes it is
likely to bring about in his or her lifestyle.
 Counseling involves interventions to prevent the
occurrence of later problems and to develop the
individual’s capacity to deal with such problems if
they should arise.
 Problems can be emancipated and then prevented
or at least minimized through discussion with the
patient.

18.  Future problems might involve the patient’s
ability and intention to adhere to the
medication directions.
 Pharmacist could point out the risks of missing a
dose of the medication and suggest
alternatives to the patient.
 Other future problems might involve the
development of side effects or adverse effects.
 The unknown is often more frightening than the
known. Knowing what to expect and what
action to take allow the patient to exert some
control over unavoidable events.

19.  Once present and future problems with medication
use have been detected, the goal of counseling is to
develop the patient’s capacity to deal with such
problems.
 The patient is an integral part of the problem solution.
 The pharmacist must discover what the patient needs
to know; what skills he or she needs to develop; and
what problems need to be dealt with. Pharmacist
must also determine which behavior and attitudes
need to be modifies.
 Finally, pharmacists can provide education and
gather information from the patients about their
needs and preferences in order to support the
physician-patient relationship.

20. HELPING GOALS OF PATIENT COUNSELING
1. To establish a relationship with the patient and to develop trust
2. To demonstrate concern and care for the patient
3. To help the patient manage and adapt to his or her medication
4. To help the patient manage and adapt to his or her illness
5. To prevent or minimize problems associated with side effects, adverse
effects, or present and future nonadherance
6. To develop the patient’s capacity to deal with such problems
7. To help the patient and other health professionals to work together
toward shared decision making.

21.  Educate the patient.
 Education involves enhancing skills and
knowledge in order to bring about
changes in related attitudes and
behaviors.
 The pharmacist’s educational goal will
be to provide information that meets the
specific needs of each patient.

22.  The educational goals of patient
counseling also involve investing patients
with the skills and techniques they need
to optimize their prescribed therapy.
 The pharmacist must provide information
and instruction in a way that makes
them effective for this particular patient
in this particular situation.
 Finally, pharmacists have opportunities to
educate other health professionals
about drug-related issues.

23. EDUCATIONAL GOALS OF PATIENT COUNSELING
1. To provide information appropriate to the particular individual and
the particular problem.
2. To provide skills and method that the patient can use to optimize the
usage and effects of the medication
3. To present information and instruction using educational method that
are appropriate to the particular individual and the particular situation
4. To educate other health professionals about drug-related issues.

24. THE HELPING APPROACH
 Health professional-centered “medical-model” approach to the
patient-centered “helping-model” approach.
 The medical model and the helping model contrast with respect
to the relationship between the health professional and the
patient.
They differ in number of areas:
 The role of each party in the relationship
 The basis for trust
 The approach to problem solving
 The allowance for the solving of future problems.

25. MEDICAL MODEL HELPING MODEL
•The health professional is active and
the patient is passive
•Both patient and health professional
are active
•The basis for trust is the presumed
expertise and authority of the health
professional, to w/c the patient
automatically responds
•Trust is not automatic, but grows slowly,
based on the personal relationship –
trust develops mutually between the
professional and the patient.
•The health professional identifies the
problems, analyze information, arrives
at a diagnosis, and gives direction to
work on the solution.
•The patient is responsible only for
answering questions and following
directions.
•The professional assists the patient in
exploring the problem and possible
solutions.
•The patient is responsible for drawing
conclusions, making decisions, and
selecting a solution he or she can
follow.
•Patient becomes dependent on the
professional.
•The patient must return to the health
professional to deal with future
problems in the previously learned way
and to seek help if necessary
•The patient develops self-confidence
to manage his or her own problems.
•Parent-child relationship •Equal relationship

26.  Pharmacists must decide for themselves where on
the continuum they feel most comfortable in their
relationship with the patient. and also where the
patient may feel most comfortable.
 To attain the counseling goals most effectively, the
pharmacist must lean more heavily toward the
helping-model approach

27. THE EDUCATIONAL APPROACH
 FOUR BASIC CONCEPTS that illuminate the conditions and
processes of adult learning:
a. Self –concept
 In adult education, the teacher and learner develop a
helping relationship, characterized by reciprocity in the
teaching-learning transaction.
 The pharmacist must join with the patient to help solve
problems relating to his or her illness and medication use.

28. b. Experience
 Adults accumulate a vast range of experience
over the course of their lifetime, which
contributes to the way they view and interpret
new experiences, and the way they approach
the need for new information.
 Patients may have certain beliefs arising out of
previous experiences of their own or out of those
of others that they have heard about.
 When teaching adults, pharmacists can draw
upon patient’s experiences as a resource – two-
way communication techniques (group
discussions, simulation, role-playing, and skill-
practice sessions)

29. c. Readiness to Learn
 Immediate concern and importance in their daily
lives.
 Adults make themselves available for learning
because of their perception of a particular need
in a particular area. They will choose what they
need to know and when they want to learn about
it.
 Pharmacist must act as a resource person to help
patients discover their own learning needs.

30. d. Time Perspective and Orientation to Learning
 Adult education involves issues of concern in the
individual’s life at present and is problem-centered.
 Through discussion with the patient, the pharmacist can
avid providing extraneous information – the kind that does
not apply to a particular patient or the particular situation.
 It is up to the pharmacist to discover from the patient the
kind of information that will be useful for solving that
patient’s specific problems and then tailor the counseling
to the particular patient.

31. THE EDUCATIONAL APPROACH: CONDITIONS AND PROCESS OF ADULT
LEARNING
1. Helping relationship, with reciprocity
2. patient’s experience is drawn upon as a resource in learning
3. Educational methods involve two-way communication techniques
such as group techniques, discussions, simulation, role-playing, and skill-
practice sessions.
4. Educational tasks involve subjects of immediate concern and
importance in the individual’s daily life.
5. Adults choose what they want to learn, and when
6. Learning is problem-centered, and involves identifying and solving the
problem in the present.