After completing the chapter, the students should be able to:

1. Describe the potential benefits of patient counseling to the patient.

2. Describe the potential benefits of patient counseling to the pharmacists.

3. Discuss how patient counseling may be seen as a service to the public and private and government insurers.

4. Describe how patient counseling fits in with the pharmaceutical care model.

5. Discuss the challenges faced by pharmacists in patient counseling.

The PPAC developed in 1998 by the

American Pharmaceutical Association

describes pharmacists’ activities.

1. Interviewing the patient

2. Obtaining patient information

3. Educating the patient

4. Providing verbal and written information

5. Discussing & Demonstrating

6. Face-to-face patient contact

7. Patient counseling

In the practice of philosophy of pharmaceutical care, pharmacists are responsible directly to the patients they serve.

Patient counseling improves patient care.

It is integral to providing competitive and professional pharmacy services.

Patient counseling and patient-pharmacist interaction are key to the pharmacist’s role today.

Improve the quality of life and provide quality care for patients.

“Drug misadventures” and nonadherenceto treatment programs reduce quality of life and interfere with quality care.

In addition, the high costs of health care today call for interventions to minimize waste and to maximize benefits of medical treatments.

Nonadherence may result in prolonging

or increasing the severity of an illness.

Lack of information about drugs is one of

the four most significant variables that

have the most bearing on reasons why

the elderly may fail to comply with their

medication regimens.

Many studies have demonstrated the

effectiveness of pharmacist provision of

information and reminders.

In addition to nonadherence and ADR,

through patient counseling pharmacists

can bring to light many other drug-

related problems such as:

1. Untreated indications

2. Improper drug selection

3. subtherapeutic dosage

4. Overdosage

5. Drug interactions, and

6. Drug use without indications

It has recently been acknowledged by the health care community that advents caused by errors in patient care and treatment are huge problems contributing to prolonged hospital stays, increased illness and suffering, and loss of confidence in the health care system.

Systems analysis of medication errors conclude that contributing factors are multifactorial and involve immediate causes stemming from situational factors at the time the drug is provided to the patient, while others involve latent conditions related to the drug provision system from manufacture and regulatory systems to the patient.

Causes:

1. Failed communication

2. Lack of patient education

3. Incorrect drug administration

4. Dispensing processes and drug distribution

5. Knowledge level of pharmacist, patient

and prescriber

Patient education has been identified by

the Institute for Safe Medication Practices

as the most important error-prevention

strategy.

In addition to reducing drug-related

morbidity and its subsequent costs to the

individual and society, patient counseling

may benefit patients in number of other

ways concerning improved outcomes and

satisfaction with care.

Quality of communication in history-taking

and during discussion of the management

plan has been found to improve emotional

health, symptom resolution, function,

physiologic measures.

Patients find communication,

interpersonal sensitivity, and partnership

with their healthcare providers to

improve satisfaction; they are

consequently more likely to adhere to

medical advice and to recall medical

information provided.

As with prescription counseling,

pharmacist counseling for

nonprescription medications can benefit

patients both medically and financially.

Finally, patients may benefit from counseling by pharmacists in non-medication related situations.

Pharmacists in ambulatory care are often the first contact with the health care system, and as such can coordinate services for the patient and family, as well as provide continuity of care.

They are also ideally situated to provide public health services such as smoking cessation and weight loss counseling and counseling on preventing or coping with disease condition.

Patient Counseling to Improve Patient Care

1. Reduces errors in using medication

2.Reduces noncompliance

3. Reduces adverse drug reactions

4. Improve outcomes

5. Increases satisfaction with care

6. Assists with self-care

7. Can provide referral assistance with non-drug-related situations (e.e,

family planning and emotional problems)

8. Reduces health care costs to individual, government and society

9. Is an integral part of providing patient-centred pharmaceutical care

Pharmacists have a professional obligation to counsel patients for many reasons including legal, personal, professional and economic.

Pharmacists are striving to be recognized by patients and other health professionals as important players in the health care team, that is, the team’s experts in the field of drugs.

Standards of practice for the profession of Pharmacy by the APA and other pharmacy organizations, as well as guidelines for patient counseling by these organizations, promote the role of pharmacists in patient counseling.

In general, pharmacists report that counseling and patient education are the greatest sources of job satisfaction, and that they want to spend more time advising and counseling.

Patient counseling offers pharmacists a chance to demonstrate professional capabilities and to use the knowledge that they have gained through many years of study.

Personal satisfaction of helping another person, particularly in helping that person to regain or maintain health.

An additional personal benefit for

pharmacist’s involvement in patient

counseling involves job stress.

Through discussion with the patient

during counseling, the pharmacist can

come to understand the patient’s

position and gain his or her cooperation,

ultimately reducing the level of stress for

both patient and pharmacist.

From the economic and business points of view, patient counseling can be seen as an extra service with the potential to entice customers.

The growing competition in pharmacy with preferred provider organizations, mail-order, managed-care pharmacies, and international pharmacies serves to emphasize the economic need for pharmacists to enhance the value of personal contact with patients through patient counseling.

Since the institution of legislation

requiring counseling in many jurisdictions,

specific consulting services such as

smoking cessation, diabetic or asthma

counseling have become more

appropriate to promote as additional

services for a fee, particularly to

pharmaceutical and insurance

companies who recognize the

sometimes long-term cost-saving

benefits.

Providing Professional Pharmacy Services through Patient Counseling

1. Provides compliance with pharmacy legislations, standards, and

regulations

2. Affords legal protection, since pharmacists may be held accountable

for injury resulting from insufficient information provided to the patient.

3. Maintains professional status as part of primary care and health care

team

4. Increases job satisfaction and reduces stress

5. Is an added service to meet patient demand and aid in market

competition

6. Increases revenue through payment for counseling services and

reduces loss resulting from unfilled or un-refilled prescriptions

7. Is an integral part of providing pharmaceutical care.

Pharmaceutical care – an integrated

patient-specific model of pharmacy

practice and assert that to deliver

pharmaceutical care the pharmacist

must see the patient, explain the

proposed relationship, discuss the various

choices, obtain information, and seek

cooperation, trust and permission.

Each step in the pharmaceutical care process

requires patient-pharmacist interaction:

1. Establishing the pharmacist-patient relationship

2. Collecting and interpreting patient information

3. Listing and ranking drug-related problems

4. Determining desired pharmacotherapeutic

goals

5. Determining feasible alternatives

6. Selecting and individualizing the most

appropriate treatment regimen

7. Designing a drug-monitoring plan

8. Implementing the decisions about drug use

9. Designing a monitoring plan to achieve desired

therapeutic goals and following up to

determine the success of treatment.

Consulting with the patient is the main source of

information necessary for the pharmacist to

provide pharmaceutical.

The pharmacists is able to develop a working

relationship, to gather the necessary facts, and to

determine the patient’s needs and wishes.

The patient is able to contribute to identifying

problems and can play a role in deciding desired

outcomes and goals, identifying solutions and

options, treatment regimens, and in developing an

individual plan.

Through regular discussion with the

patient, the pharmacist can ensure that

the patient carries out the plan and that

the plan is successful from both the

pharmacist’s and patient’s point of view.

Thus, patient counseling is an integral

part of pharmaceutical care.

Challenges to Providing Patient-Counseling Services

System challenges Lack of time

Lack of incentives – economic, regulatory

Workforce dynamics

Lack of quality measures and processes

Lack of culture of quality improvement and

accountability for patient outcomes

Lack of policy change (corporate, health care)

Regulations

Lack of acceptance by phycisians

Pharmacy environment Lack of privacy

Physical barriers

Inaccessibility of the pharmacist

Atmosphere conducive to communication

color, light, sound)

Patient challenges Patient’s poor perception of the pharmacist

Lack of awareness on the part of the patient

of the need for counseling and of its

availability

Comprehension difficulties

Lack of time

Lack of choice

Pharmacist challenges Lack of knowledge about drugs

and the patient’s history)

Lack of confidence

Lack of skills (problem solving,

interpersonal, counseling, self-

assessment)

Busyness and poor prioritization

and time management

Business skills

Lack of resources (software,

designated space)

Perception of the importance of

the patient’s need for the

information

Inability to disengage old practice

model

Lack of ability/knowledge to

change

The challenge of change Global practice reorientation

Internal and external changes

needed

Structural changes

Procedural changes

Role orientation

Change in organization culture