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INTRODUCTION Safe and effective drug therapy depends on patients being well informed about their medication . Most pharmacists in community pharmacies and hospitals have not been educated and trained for counseling and have largely remained as prescription fillers or dispensers. As a result many patient do not get enough information about use of their medication, including how and when to take the medication, how long to take it, what to do if side effects occur or a dose is missed. Lack of information may lead to the therapeutic failure, adverse effects, additional expenditure on investigations and treatment or even hospitalisation .


DEFINITION Patient counselling refers to the process of providing information , advice and assistance to help patients use their medications appropriately. According to USP, medication counseling is an approach that focuses on enhancing the problem solving skills of the patients for the purpose of improving or maintaining the quality of health and quality of life.

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The information is usually given verbally , but may be supplemented with written materials . During counseling, the pharmacist should assess the patients understandings about his or her illness and treatment, and provide individualized advise and information which will assist the patient to take their medication 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 patients disease.


OBJECTIVES OF P.C Good communication skills are needed to gain the patients confidence and to help motivate the patient to adhere to the recommended regimen. Effective patient counselling aims to produce the following results 1) Better patient understanding of their illness and the role of medication in its treatment. 2) improve medication adherence 3) more effective drug treatment 4) reduced incidence of adverse effects and unnecessary healthcare costs. 5) improved quality of life for the patient. 6) better coping strategies to deal with medication related adverse effects. 7) Improved professional rapport between the patient and the pharmacist.

Communication skills for effective counselling :

Communication skills for effective counselling Communication is the transfer of information meaningful to those involved. It is the process in which messages are generated and sent by one person and received and translated by another person. The communication process between health professionals and patients serves two primary functions. 1. It establishes an ongoing relationship between the professional and the patient. 2 . It provides the exchange of information necessary to assess a patient’s health condition, implement treatment of medical problems, and evaluate the effects of treatment on a patient’s quality of life.

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The healthcare professional must be able to - understand the illness experience of the patient - perceive each patient’s experience as unique - good relationship with patients - build a therapeutic alliance with patients to meet mutually understood goals of therapy - develop self-awareness of personal effects on patients

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Communication during drug therapy - Purpose of medication - How medication works - Dose and duration of therapy - Goals of therapy - How effectiveness will be monitored - Adverse effects and how to deal with them - Drug specific issues

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Communication skills of pharmacists can facilitate formation of trusting relationships with patients . An effective communication process can optimize the chance that patients will make informed decisions, use medications properly, and meet therapeutic goals. Interpersonal communication is the transmission and reception of verbal and non-verbal messages between people. Listening is an ability which effectively enhances the communication process. Non-verbal communication consists of meaning conveyed through body language and facial expressions.

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Interactive communication involves dialogue with patients involving health condition or treatment. Patients are engaged in conversation so practical matters are covered by the doctor. Empathy is the ability to see the world through another person’s eyes and perceive his or her emotions.


BARRIERS TO EFFECTIVE COMMUNICATION Barriers to effective communication include PHYSICAL, PSYCHOLOGICAL, ADMINISTRATIVE OR TIME CONFLICT. Such conflicts prevent effective communication from being established.


PHYSICAL BARRIERS Environmental barriers such as a lack of privacy or furniture that creates physical barriers between patients and doctors/pharmacists can prevent effective communication. Environmental barriers are examples of physical barriers.


PSYCHOLOGICAL BARRIER 1) Semantics relate to meanings of words and symbols used in interpersonal communication. Words only contain meaning in terms of people’s reactions to them. Words can also have multiple meanings. Therefore, effective patient communication requires the use of words that are carefully chosen. Semantics is an example of a psychological barrier.

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2) Perception is how a message is perceived by a patient. The patient may view the doctor as only being interested in diseases, drugs and money, not people. If the patient views the doctor as being incompetent or uncaring, he/she is less likely to trust the doctor’s advice. Perception is an example of a psychological barrier. 3) Negative attitude from doctors or pharmacists are usually caused by a lack of confidence and low self-esteem. Communication is far from ideal all the time, and doctors or pharmacists should strive to improve their skills through practice. Many doctors believe that it is not their job to counsel their patients, but it is. Negative attitude is an example of a psychological barrier.

Personal barriers:

Personal barriers include low self-confidence, shyness, dysfunctional internal monologue, lack of objectivity, cultural differences, discomfort in sensitive situations, and conflicting values to healthcare practice. Personal barriers

Administrative barriers:

Administrative barriers Administrative barriers such as management may view the lack of money compensated for communication as a reason not to communicate. More money is made by prescribing medication, not caring for patients.


TIME BARRIERS Time barriers are interlinked with administrative barriers because management is responsible for staffing levels as well as allocation of work duties. Time limits are very common when it comes to pharmacists and patients. Time restraints are often excuses not to counsel, though it often does not take very long.


Environment 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. The design and placement of desks and counters should minimize barriers to communication. The environment should be equipped with appropriate learning aids, e.g., graphics, anatomical models, medication administration devices, memory aids, written material, and audiovisual resources.


STEPS DURING PATIENT COUNSELLING The following are the steps to be followed during patient counselling 1) Preparing for the session. 2) Opening of the session. 3) Counselling content. 4) Closing the session.

Process Steps:

Process Steps 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.

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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. They should also be asked to describe any problems, concerns, or uncertainties they are experiencing with their medications.

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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.

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4) 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.

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5) 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.

Counselling Content:

Counselling Content 1. The medication’s trade name, generic name, common synonym, or other descriptive name(s) and, when appropriate, its therapeutic class and efficacy. 2. The medication’s use and expected benefits and action. This may include whether the medication is intended to cure a disease, eliminate or reduce symptoms, arrest or slow the disease process, or prevent the disease or a symptom. 3. The medication’s expected onset of action and what to do if the action does not occur. 4. The medication’s route, dosage form, dosage, and administration schedule (including duration of therapy). 5. Directions for preparing and using or administering the medication. This may include adaptation to fit patients’ lifestyles or work environments.

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6. Action to be taken in case of a missed dose. 7. Precautions to be observed during the medication’s use or administration and the medication’s potential risks in relation to benefits. For injectable medications and administration devices, concern about latex allergy may be discussed. 8. Potential common and severe adverse effects that may occur, actions to prevent or minimize their occurrence, and actions to take if they occur, including notifying the prescriber, pharmacist, or other health care provider. 9. Techniques for self-monitoring of the pharmacotherapy. 10. Potential drug–drug (including nonprescription), drug–food, and drug–disease interactions or contraindications .

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11. The medication’s relationships to radiologic and laboratory procedures (e.g., timing of doses and potential interferences with interpretation of results). 12. Prescription refill authorizations and the process for obtaining refills. 13. Instructions for 24-hour access to a pharmacist. 14. Proper storage of the medication. 15. Proper disposal of contaminated or discontinued medications and used administration devices. 16. Any other information unique to an individual patient or medication.



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