UNIT 3-(C).pdf PATIENT COUNSELLING- PHARMACY PRACTICE

1. UNIT 3-© COUNSELING
DR.V.RAKSHANA
ASSISTANT PROFESSOR
FOP,BIHER

2. What is Patient Counselling?
Patient counselling refers to the process of providing information, advice and assistance to
help patients use their medications 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.
During counselling, the pharmacist should:
Assess the 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 disease. Good communication skills are required to gain the patient's
confidence and to motivate the patient to adhere to the recommended regimen.
Effective patient counselling aims to produce the following results:
*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

3. Communication Skills for Effective Counselling
The counselling process uses
* verbal and
* non-verbal communication skills.
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.
Language: When speaking to patients, use simple language and avoid unnecessary medical terminology. If possible, speak
the patient's own language.
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.
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.
Although it may be necessary to speak more loudly to patients with a hearing problem, most deaf patients gain more benefit
if the speaker moves closer, and directs their voice towards the patient's ear.
Speed: The clarity of our communication depends on our rate of speech. Patients may be reluctant to interact with a
pharmacist who speaks quickly because they may feel the pharmacist is too busy.This may happen if the pharmacist is
nervous or is uncertain about the information being given. In contrast, a person who speaks too slowly may lose the interest
of the listener. For good verbal communication, the pharmacist should present clear, relevant messages 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.

4. 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.
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.
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.
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
Steps of Patient Counselling
Counselling is a two-way communication process, and interaction between the patient and the pharmacist is essential for
counselling to be effective.
Preparing for the session: The success of counselling depends on the knowledge and skill of the counsellor.The
pharmacist should know as much as possible about the patient and his/her treatment details. In the hospital setting, this
may be accomplished by referring to the patient's case notes. In the community pharmacy setting, sources of information
include the patient and their prescription, and in some cases, a record of previous dispensing for the patient. If the patient
is receiving a medication which is unfamiliar to the pharmacist, then a drug information reference should be consulted
before counselling commences.Another issue worth considering is the mental and physical state of the patient. If the
patient is in a hurry, in pain or is not communicative, it is very difficult to counsel the patient effectively. In such situations,
the aims of counselling may need to be modified, or with the patient's agreement, the session may be postponed to a later

5. Opening the session: The first phase of counselling is used for information gathering.The pharmacist should introduce
him or herself to the patient and greet them by name. If help is required in pronouncing the name, ask colleagues or the
patient directly. It is best to use titles such as Ms, Mrs and Mr and then switch over to the patient personal problem, pass
moral judgments, interrupt when the patient is speaking, make premature interpretations or argue with the patient. If the
patient becomes hostile or aggressive despite the pharmacist's best efforts to calm him or her, it is preferable to
terminate the counselling session.
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 interactions medication or dietary
* 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

6. Because of time constraints, it is often necessary to prioritise these points. Some patients are more
interested in learning about their medication than others and the information which is given should be tailored to the
individual patient. It is important that the pharmacist uses language which is understandable to the patient. Medical
jargon and even simple medical terms will not be understood by most patients and should be avoided.This means
developing fluency with a simple vocabulary which nevertheless can be used to describe medication use accurately. So
instead of saying "This medication is for hypertension' it is better to say 'This medication is for high blood pressure’.
In some situations it is important not to jump to conclusions about why a particular medication has been
prescribed. For example, tricyclic anti-depressants are often used for conditions other than depression, such as
neuropathic pain, incontinence .Asking questions such as 'What has the doctor told you about this medication?' can help
avoid misunderstandings in this type of situation.
Sometimes the patient's family may visit the pharmacy to collect the medication.They should be provided with suitable
advice after gathering information such as their relationship with the patient and their awareness of the patient's disease
& medication history.
Closing the session:
Before closing the session, it is essential to check the patient's understanding.This can be assessed
by feedback questions, such as 'Can you remember what this medication is for?' or 'For how long should you take this
medication?". During the discussion, some of the patient's information needs may have been cleared, but the patient may
have new questions or doubts. It is therefore advisable to finish the session by asking the patient 'Do you have any
questions?". Before final closure and if time permits, summarise the main points in a logical order. If appropriate, the
pharmacist can supply their telephone

7. Counselling Aids
When information is provided to the patient verbally, there is a chance that the patient may forget the information over a
period of time. A variety of teaching and educational aids have been developed to assist patient counselling. If
information is provided in a printed format, the patient can go through the information at leisure as and when the
information is required.
Medication cards can be a useful aid, particularly for patients on many medications on a long-term basis. A
medication card is a written summary of a patient's medications, presented in a way which is easy for the patient to
understand.
An example of such a card Cards may be written by hand or generated by computer. Once a card is given to
a patient, it can be used to assist the patient to organise their medication routines at home and to show to other
healthcare providers. It is important that the card is updated when changes to the medication regimen are made. Patient
information leaflets (PILs) produced by drug manufacturers for their products are known as consumer product
information (CPI) or consumer medicine information (CMI). PILs are written information n leaflets in simple language
about the patient's illness and its treatment, including medications and relevant lifestyle changes. Printed materials
reinforce verbal advice and may result in improved understanding and acceptance of treatment recommendations.
Written information should be considered as a supplement to verbal counselling, rather than a
replacement, and is of course only useful for patients who are literate.
Pharmacists can also develop useful PIL using their knowledge of therapeutics and the local language. However, it is
essential that such materials are peer reviewed to ensure accurate and high-quality content. In a hospital setting, it is also
wise to seek the input and approval of relevant medical staff.
While preparing PILs, reading case, layout and design are very important.To assess the reading case of any PIL written in
English, the Flesch Reading Ease (FRE) formula can be used.The reading ease scores in FRE scale are 0-100. If the score is
less than 60, the document is considered to be difficult for the general public to read.The ideal PII. should have a
readability score of 70-80.

8. The reading ease score can be calculated by using the following formula:
FRE206.84 0.85W-1.025where W is the number of syllables per 100 words and S is the number of words in an average
sentence. From this formula it can be seen that readability is improved if simple words are used in short sentences,
Barriers to Patient Counselling
Patient counselling may not take place in community pharmacies due to various reasons, known as barriers.These
barriers are classified as patient-based, provider- based and system-based barriers.
Patient-based barriers: In India, many patients are unaware that pharmacists may provide counselling and generally ask
their prescriber about medication use. Gender and language differences may also inhibit patients from asking the pharmacist
about medication use information.
Provider based barriers: Many pharmacists lack the confidence to counsel patients due to lack of knowledge and
counselling skills.A heavy patient load for prescription filling is also an important barrier in many practice situations.
System-based barriers: In India, counselling is not a mandatory legal requirement and officially pharmacists 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 counselling service. Lack of privacy in many busy community and hospital pharmacies can also
be a problem.
Strategies to overcome barriers: By definition, provider-based barriers are the easiest to modify. Pharmacists can start by
updating their knowledge and counselling skills.Confidence can be developed by initially focusing on one particular disease
or group of drugs (for example, antibiotics).A good approach is to ask patients 'Have you used this medication before?' when
they collect their prescription. Encouraging individual patients to ask questions about their medications or media campaigns
will also improve counselling opportunities.

9. Note:u can learn the previous slides for steps of patient counseling or u can learn this slide :
STEPS INVOLVED IN PATIENT COUNSELING
The following are the steps to be followed during patient counseling:
1. Preparing for the session
2. Opening of the session
3. Counseling content
4. Closing the session
1. Preparing for the session:The pharmacist should tell the purpose and expected length of the sessions, and obtain the
patient's agreement to participate. Determine the patient's primary spoken language. 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.
2. Opening the session: At start of session, focus on information gathering from patient:
i. Introduction from pharmacist, make the patient comfortable
ii. State objective of meeting
iii. Seek information from patient regarding his medication, understanding of his disease and other supplementary
information such as previous allergies, past medications, smoking, alcohol history, etc.
iv. It also includes the open-ended questions which help in patient understanding of disease like:
•What symptoms patient is experiencing? •What did the doctor tell patient about the disease?
• Q on patient understanding of his/her medication.
•What did the doctor tell patient about this medication?
3. Counseling content: It is the main part of session. In this session pharmacist speaks about medication and lifestyle
changes like:
i. Name/strength of drug
ii. How long, how to be taken

10. iii. Expected benefits, timeframe
iv. Possible side effects and interactions
v.What to do if missed dose is missed and special storage conditions requirements.
vi. Pharmacist speaks about medication and lifestyle changes.
vii. Counseling in simple language and also advising the family members.
4. Closing the session: This usually done by asking simple questions. Before ending, important to know patients
understanding of his/her medication.This usually done by asking simple questions. Example:What is the drug, how many
times in a day drug was taken, which one after meal, which one empty stomach, etc.?
SPECIAL CASES REQUIRING PHARMACIST
Unlike acute illness where the patient get himself treated at an ambulatory care center or admits himself for a short period
in the hospital, the chronic illness require hospital stay, self- monitoring, follow-up, lifelong drug therapy.
The chronic diseases are strongly linked to specific behaviors such as smoking, diet, sedentary
lifestyle, intravenous drug abuse, etc. Pharmacist helps in prevention and effective treatment of these diseases.
Hypertension if uncontrolled can lead to a huge adverse impact on quality of life.The management of hypertension
requires non-pharmacological as well as pharmacological methods. A pharmacist can counsel the patients regarding
weight loss and regular exercise, sodium and calorie restriction, restriction of alcohol intake, stopping smoking, self-
monitoring of blood pressure, etc.
Diabetes is a chronic disease with altered carbohydrate, lipid and protein metabolism which affect the
quality of life of diabetic patients.Various factors like understanding of the patients about their disease, socioeconomic
factors, dietary regulation, self-monitoring of blood glucose are known to play a vital role in diabetes management.The
pharmacist can educate the patients about the proper use of medications, drug interactions.The pharmacist can give an
overview of diabetes, stress and psychosocial adjustment, family involvement and social support, nutrition, exercise and
activity, monitoring and use of results, relationship between nutrition, exercise, medication, and blood glucose level.

11. Coronary heart disease is also a chronic disease in which pharmacist can play an active role in the
management of this chronic illness in several ways. Non-pharmacological measures like education regarding diet, smoking,
and exercise and encouraging the patients to maintain a diary on anginal attacks, pain symptoms, etc. Pharmacological
measures like educating the patients on the use of nitrates in case of an acute anginal attack.
Asthma is a chronic condition requiring lifelong drug therapy. Pharmacist can play an active role in
counseling the patient regarding self-monitoring of drug therapy, other life- style modifications and usage of specialized
dosage forms such as metered dose inhalers, dry powder inhalers, spacers, etc. Non-pharmacological measures include
safety measures while traveling, prophylactic use of drugs before exercise, avoidance of allergens, stopping cigarette
smoking, etc.