Role of pharmacist in patient counselling

Authors:-
Gehlot Shrawan. & Phalke Aishwarya.

Toll free: 1800220234 | www.met.edu
Bhujbal Knowledge Centre
• Patient Counseling is defined as
providing medication
information Orally or in written
form to the patients or their
representatives on:
– directions of use
– on side effects
– precautions
– storage
– diet
– life style modifications.

• During counseling, the pharmacist should assess patient’s
understanding about his or her illness and the treatment, and
provide individualised advice and information which will assist
the patient to take their medications in the most safe and
effective manner.

• To provide accurate advice and information, the pharmacist
should be familiar with the pathophysiology and therapeutics of
the patient’s diseases.
• Good communication skills are required to gain the patient’s
confidence and to motivate the patient to adhere to the
recommended regimen.

• Patient should recognize the
importance of medication for
his well being.
• Improved medication
adherence.

• Patient’s understanding of
strategies to deal with
medication side effects and
drug interactions should be
improved.
• Reduced incidences of
medication errors, adverse
effects and unnecessary
healthcare cost.

• Improved quality of life of the
patients.
• Should ensure better patient
compliance.
• The pharmacist should be
perceived as a professional
who offers pharmaceutical
care

• Pharmacist is the ideal person to counsel the patient . He is the
link between the patient and the doctor.
• Throughout the world, over the past four decades, there has
been a consolidated effort to shift the concept of pharmacy
practice from its earlier focus on medicine supply to patient care.
Doctor Pharmacist Patient

• An important responsibility of contemporary pharmacy practice
is to ensure appropriate and safe drug therapy which is cost
effective and socially committed.
• By taking direct responsibility for individual patient's medicine
related needs, present day pharmacists are contributing their
professional responsibility to the positive outcome of drug
therapy and to the patient's quality of life

• In 1996, for the first time, a separate patient center was
established in the Govt. Medical College, Trivandrum.
• Starting of Patient Counseling Center was one of the specified
objectives of starting the department.
• The patient counseling center was first started in a separate open
area of the Community pharmacy.

• A team of five young comprising of one M.Pharm, one B.Pharm
and Diploma pharmacists lead the counseling activities.
• It was started in a humble manner with a table, few chairs and
certain essential reference books.
• Within a short period, people found the services of the center
much useful and beneficial for the right use of medicines.
• Long serpentine queue started appearing in front of the patient
counseling center and by 1997, the center became a 24 hour
service.

• The counseling process uses verbal and non verbal
communication skills.
• So, the way in which we speak has an important impact on
patient understanding.

• Verbal skills involve:
– Language
– Tone
– Volume
– Speed
• Non Verbal skills involve:
– Proximity
– Eye Contact

Verbal Communication Skills
• Language: When speaking to
patients, use simple language and
avoid unnecessary medical
terminology. If possible, speak the
patients own language.

• Tone: During counseling, the tone
of our voice has a great impact on
patient understanding. The tone of
the voice should be caring and
reassuring.
• Volume: Ideally, counseling should
be conducted in a quiet, private
setting where it is unnecessary to
raise ones voice.

Speed: For, good verbal communication, the pharmacist should
present clear, relevant message in a logical sequence, and at a
speed which gives the patient time to think about what is being
said. This will help the patient understand and remember the
concepts more easily.

Non Verbal Communication Skills
Proximity: This refers to the distance
that people maintain between
themselves during the counseling
process. Generally, the counselors and
healthcare professionals use intimate
or personal proximities.

Non Verbal Communication Skills
Eye Contact: The amount that people look at one another during
conversation varies depending on whether they are speaking or
listening. For cultural or personal reasons such as timidity, sadness
or depression, some people avoid looking into the counselors eyes.

Steps
1.Preparing for the
counseling session
2. Opening of the
counseling session
3. Closing the
counseling session

1. Preparing for the counseling session:
• The success of counseling depends upon the knowledge and
skills of the counselor, the pharmacist should know as much as
possible about the patient and his or her treatment details.
• In the community pharmacy settings, sources of information
includes the patients and their prescription and in some cases, a
record of previous dispensing and medication history for the
patient.

1. Preparing for the counseling session:
• Before counseling, patients state of mind
and his physical state must be known to
the counselor.
• If the patient is in hurry, in pain or non
communicative, it is very difficult to
counsel the patient effectively.
• In these conditions, counseling schedule
may be modified or postponed to a later
date.

2. Opening of the Counseling Session:
During counseling, The pharmacist should gather information from
patients about the following:
• Disease and its duration.
• Drug treatment
• Medications

• Use of alternative medicines such as
ayurvedic, unani or other system.
• Past medical history.
• Personal habit such as chewing of
paan masala, cigarette smoking and
alcoholism.
• Drug allergies

• During counseling, the pharmacist may best avoid…
Arguing with the patient
Making premature interpretation and
Interrupting when the patient is speaking
Passing moral judgments
Discussing the patients personal problems
Showing excessive curiosity
Asking questions in a direct or embarrassing way

• Counseling Content:
– The counseling content is considered to be the heart of the
counseling session.
– Life style changes such as diet or exercise may also be discussed.

• Topics commonly covered include…
The name of the medicine
Removal of drug from package
Route of administration
Time of administration
Duration of use
Proper storage of drugs
Allergies
Side effects
Drug interactions
Refill information

3. Closing counseling session:
• Before closing, the pharmacist must check that the patient has
understood what has been communicated to him.
• Before the final closing, the pharmacist should summarize the
main points in a sequential manner.

3. Closing counseling session:
• If possible, the patients should be encouraged to make contact if
they need further assistance and advice via email or personal
contact or telephonic communication.
• The closing discussion should also be used to reiterate and
emphasize the most important points of the counseling, since
the last message heard is more often the one that is
remembered best.

Medication Card
• Medication card can be useful aid, particularly for patients on
many medications on a long term basis.
• A medication card is a written summary of a patients medication,
presented in a way which is easy for the patient to understand.

Pictogram
• Pictogram is a schematic information in the form of simple
pictures, about the duration of use or precautions to be taken by
the patients during the medication.

Patient Information Leaflets (PILs)
• Patient information leaflets are
produced by drug manufacturer for
their product are known as
Consumer Product Information (CPI)
or Consumer Medicine Information
(CMI).
• It is a common literature provided
with medicine.
• It bears all information about
medicine, from its chemical nature,
its formula up to its direction for use
and dose.

Patient Based Barrier
• In India, many patient are unaware that pharmacist may provide
counseling and generally ask their prescriber about medication
use.
• Gender and language differences may also inhibit patient from
asking the pharmacist about medication use information.
• Many pharmacist lack the confidence to counsel patients due to
lack of knowledge and counseling skills.
• A heavy patient load for prescription filling is also an important
barrier in many practice situation.

System Based Barrier
• In India, counseling is not a
mandatory legal requirement and
officially pharmacist are not entitled
to charge for dispensing or for the
information provided to patients.
• These factors act as regulatory and
financial disincentives to providing a
counseling service.
• Lack of privacy in many busy
community and hospital pharmacies
can also be a problem.

• By definition, provider-based barrier
are the easiest to modify.
Pharmacists can start by updating
their knowledge and counseling
skills.
• Confidence can be developed by
initially focusing on one particular
disease or group (for e.g.
antibiotics).

• A good approach is to ask patient
‘Have you used this medication
before?’ When they collect their
prescription.
• Encouraging individual patient to
ask questions about their
medications or media campaigns
will also improve counseling
opportunities.

• Despite the above mentioned barrier,
some pharmacists in community
pharmacies are showing interest in
educating their patients about
medication use.
• They also offer various health
screening services such as blood
pressure and blood glucose
measurement.
• State Pharmacy Councils conduct
continuing pharmacists to help update
their therapeutics knowledge and
counseling skills.

• Patient counseling is an essential component of clinical pharmacy
practice in hospitals and in community pharmacy settings.
• Counseling enhances the patient’s understanding of their illness
and its treatment, and may improve adherence and therapeutic
outcome.
• It allows pharmacists to gain first-hand knowledge of medication
use from the patient’s perspective.

1. A Textbook of Clinical Pharmacy Practice by G Parthasarathi,
Karin Nyfort-Hansen and Milap C Nahata.
2. Clinical Pharmacy by Dr. H.P.Tipnis and Dr. Amrita Bajaj.
3. Suresh B. Shaping the pharmacy profession. Ijhp2008;45(1):4
Lee AJ, Borham A, Korman NE, et al.
4. Staff development in pharmacist-conducted patient education
and counseling. Am J Health Syst Pharm 1998; 55:1792-8

Role of pharmacist in patient counselling

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