Patient counseling, problems in counseling and others, role of pharmacists, role of patients, ASHP guideline

1. Patient Counseling
Presented by: Ayushma shahi,Anil Bishwakarma and Manij Joshi.

2. Introduction
• Continuous improvement of quality and safety in patient care has become
imperative. Patient education about medication is an essential component of
the practice of pharmaceutical care. In this context, counseling is ‘a face-to-
face interaction between the pharmacist and the patient or caregiver’.
• Pharmacists, being the last contact of patients before they take medication,
have the opportunity and responsibility to safeguard the patients’ health and
to help ensure the success of the drug therapy by providing appropriate
counseling to maximize their chance of solving on desired therapeutic
outcomes.

3. Definition
“Counseling is the process of giving and receiving information in a way that is
meaningful, memorable and usable, changes behavior and facilitates a
successful rehabilitative outcome.”
• Patient counseling should include an assessment of the patient’s understanding
and comprehension of the appropriate use of their medication.
• It should also include an assessment of the patient’s awareness of how to use the
information given by the pharmacist in order to ensure more positive outcomes of
the prescribed medication.

4. • Effective medication counseling has a significant effect on patients’
compliance with the treatment plan. Without sufficient knowledge, patients
cannot efficiently manage their own care. Consequently, failing to adhere to
treatment instructions commonly leads to serious negative outcomes such
as disease progression, lowered quality of life and death, in addition to
increased health care costs.

5. Topics that pharmacists need to address with
patients include, but are not limited to the
following:
• Name and description of the medication
• Route of administration
• Dose
• Dosage form
• Duration of drug therapy
• Special directions and precautions for preparation of drugs
• Administration and use by the patient

6. Contd..
• Interactions and therapeutic contraindications that may be encountered
(including their avoidance and the action required if they occur).
• Techniques for self-monitoring drug therapy
• Proper storage
• Refill information
• Appropriate action in case of a missed dose

7. Environment
• Education and counseling should take place in an environment conducive to patient
involvement, learning, and acceptance— one that supports pharmacists’ efforts to establish
caring relationships with patients. Individual patients, groups, families, or caregivers should
perceive the counseling environment as comfortable, confidential, and safe.
• Education and counseling are most effective when conducted in a room or space that ensures
privacy and opportunity to engage in confidential communication. If such an isolated space is
not available, a common area can be restructured to maximize visual and auditory privacy from
other patients or staff.
• Patients, including those who are disabled, should have easy access and seating. Space and
seating should be adequate for family members or caregivers.
• The environment should be equipped with appropriate learning aids, e.g., graphics, anatomical
models, medication administration devices, memory aids, written material, and audiovisual
resources.

8. Process Steps (ASHP Guideline)
1. Establish caring relationships with patients as appropriate to the practice setting
and stage in the patient’s health care management. Introduce yourself as a
pharmacist, explain the purpose and expected length of the sessions, and obtain the
patient’s agreement to participate. Determine the patient’s primary spoken language.
2. Assess the patient’s knowledge about his or her health problems and medications,
physical and mental capability to use the medications appropriately, and attitude
toward the health problems and medications. Ask open ended questions about each
medication’s purpose and what the patient expects, and ask the patient to describe or
show how he or she will use the medication. Patients returning for refill medications
should be asked to describe or show how they have been using their medications.
They should also be asked to describe any problems, concerns, or uncertainties they
are experiencing with their medications.

9. 3. Provide information orally and use visual aids or demonstrations to fill patients’
gaps in knowledge and understanding. Open the medication containers to show
patients the colors, sizes, shapes, and markings on oral solids. For oral liquids and
injectables, show patients the dosage marks on measuring devices. Demonstrate the
assembly and use of administration devices such as nasal and oral inhalers. As a
supplement to face-to-face oral communication, provide written handouts to help
the patient recall the information. If a patient is experiencing problems with his or her
medications, gather appropriate data and assess the problems.Then adjust the
pharmacotherapeutic regimens according to protocols or notify the prescribers.
4. Verify patients’ knowledge and understanding of medication use. Ask patients to
describe or show how they will use their medications and identify their effects.
Observe patients’ medication-use capability and accuracy and attitudes toward
following their pharmacotherapeutic regimens and monitoring plans.

10. Counseling to enhance medication adherence
1. Motivational Interviewing
- Many pharmacists give patients advice about the importance of medication
adherence by simply telling them to take their medication as directed. Patients
may passively agree to take their medication regimens but not follow through. This
approach to counseling patients is not effective because it fails to explore the
patient’s barriers and motivations toward being adherent to the regimen and does
not address the patient’s readiness to commit to following through with the
prescribed plan.
- Motivational interviewing is an alternative form of communication that combines a
patient-centered yet directive approach to discussing medication adherence and
health behavior change. Motivational interviewing focuses on the patient’s own
motivation for change and adherence to treatment and identifies reasons why a
patient may be ambivalent or resistant to making a change.

11. 2. Understanding of disease, medications
- Patients with a poor understanding of their disease and medication regimen and their
personal consequences of nonadherence are more likely not to take their medications
properly.
- Patients should be educated about the benefits of treatment and what may happen if
medications are not taken as prescribed. Counseling should be tailored to address a patient’s
specific diseases (e.g., a stroke may occur if blood pressure medications are missed).
- To enhance adherence, key points of the medication regimen should be reinforced, such as
how the medication works, the proper dosage schedule and administration (e.g., show
patients how to use an inhaler), what to do if doses are missed or delayed, proper storage, and
common and serious adverse events.
- Use the “teach back” method to assess whether patients understand what you told them.
The following is an example of a teach-back question: “I want to be sure I explained everything
clearly. Can you tell me the two main adverse effects of your new medicine?” When using this
method, try to place the burden back on yourself to help the patient feel at ease.

12. 3. Simplifying regimen, patient reminders
Trying to incorporate the dosage schedule into the patients’ schedule and
lifestyle and using patient reminders are other interventions aimed at
enhancing adherence. Talk to patients to determine the best time for them to
take medications and find out if regimens with multiple daily doses may be
problematic. Converting regimens to once-daily dosing options and reducing
pill burdens by using combination tablets may be beneficial interventions for
improving adherence. Patient reminder aids such as medication calendars, pill
boxes, and/or telephone or mail reminders may also enhance adherence.

13. 4. Addressing cost issues
Given the high cost of drugs, the issue of reimbursement and access to care
should be addressed with all patients.
Medication nonadherence may be a result of a patient’s inability to pay for
prescribed therapies.
Talk to patients about insurance coverage, access to assistance programs, and
the availability of cheaper options if cost barriers influence adherence.

15. Reference
• https://www.pharmacist.com/counseling-enhance-medication-adherence
• American Society of Health-System Pharmacists. ASHP guidelines on
pharmacist-conducted patient education and counseling. AmJ Health-Syst
Pharm. 1997; 54:431–4.
• Layqah L.The practice of counseling in pharmacy: patients’ perspectives. J
Anal Pharm Res. 2018;7(4):472‒476. DOI: 10.15406/japlr.2018.07.00269