1-sir allah baksh counselling
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8/7/2019 1-sir Allah baksh counselling
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PATIENT COMMUNICATION & COUNSELLING
Malik Allah Bukhsh Awan
Lecturer Institute of Pharmaceutical Sciences,
UVAS, Lahore
Objectives
• Elements of communication
• Barriers to communication
• Patient counselling
• Need for patient counselling
• How to counsel
‘You never get a second chance to make a first impression’
IN ANY COMMUNICATION
verbal communication
• Actual words convey only 10% of the message
Non verbal communication
• How it is said (40%)
• Body language (50%)
Vocal Communication Paralanguage
Vocal characteristics
• Quality & fluency of voice
• ‘Thank you for asking the question’
Body Language
• Gestures
o Do some ‘people watching’
• Facial Expressions
• Eye contact
• Physical contact
• Body posture
Barriers to Communication
1. Environment
2. Patient factors
3. The pharmacist
4. Time
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Counselling needs
To be related to the age, experience, & understanding of the individual patient
Pharmacist should ensure that the patient understand -
• how to take / use the medicine• how to follow correct dosage schedule
• Any effects on driving / work
• Any food / drugs to be avoided
• What to do if a dose is missed
• Possibility of staining of clothes / skin by medicine
• Special need for Counselling
• Unusual method / time of administration
Potential interaction with a common food / domestic remedy
The Need for counselling
• Difficulty in taking / using medicines
• Difficulty in complying with dosage regimens
• 5O % elderly people fail to take medicine as intended
• 80% of above 75 year of age use at least 1 drug
• & 36% more than 4 drugs
• Pharmacist counselling
• Better compliance
• Less therapeutic failure
• Cost of medicines returned to pharmacies 100 £/year in UK because????
• Poor understanding of PIL
• Information / counselling for POM & OTC
Aims of counselling
• Encourage patients to identify any problem related with their medicines
• Encourage patients to develop their own action plan for taking / using medicine correctly
• Gain an understanding of patient perspective
• Respect the patient believes
Opportunities for Counselling
• Pharmacist last health care professional whom patient sees before starting therapy
• Prominent & proactive role• End of dispensing process
• Integral part of dispensing in community pharmacies
o Direct request of medicine by customer
o Request for advise on minor ailment
o Self care programs for chronic diseases
o Diagnostic testing / screening facilities
• Computer aided counselling systems
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• Hospital pharmacists
o Sufficient information by PMR
o Medicines alteration
o Counselling at discharge
How to counsel
• Structured & systematic manner
• Sound knowledge about medicines & appliances
• Excellent communication skills
• Explain information clearly, unambiguously & in a language patient can easily understand
• Which question to be asked & how to ask from patient
• Counselling process should not be mono-language
• Don’t provide irrelevant / excessive information
• Two way process
• Ample opportunity for patient to ask questions
• Pharmacist should know how to listen the patient
• Introduce aids for comprehension, if necessaryo Explanatory leaflet, placebo device, diagram, etc
Minimum information to included in counselling
• How to take / use medicine
• When to take / use medicine
• How much to take / use
• How long to continue
• What to expect from therapy?
• Why medicine (s) are being used
• What to do if something goes wrong? (missed dose)
• How to recognize & minimize side effects
• Life style modification if required
• Dietary changes if needed
Consideration of the medicine
• Single item Vs multiple item prescription
• Complex dosgae regimens
• Special delivery methods
• Novel packaging
• Narrow therapeutic index
• Potential for drug / food interaction (BNF Appendix-1&9 )• Potential to cause side effects (how much information?)
• New drugs under extensive surveillance by CSM
• Medicines which require special storage requirements
• Appendix-9 (BNF) cautionary & advisory labels (e.g, Vibramycin)
Consideration of the patient
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• Which patient require counselling
• Level & type of information
• Is patient known at pharmacy?
• Has he/ she previously identified problems with drug
• What counselling previously received
• Patient comprehension level• Age of patient
• Pregnant & breastfeeding
• Physical disabilities
• Mental disabilities
• Compliance level
• Purchase of an OTC incompatible with POM
• Patient refusing to take POM (Compliance problem??)
• Patient asking an OTC, which is being used to treat side effect of POM
Aids to counselling
• PIL
• Placebo devices
• Warning cards
Stages in the counselling process
• Recognizing the need for counselling
• Assessing & prioritizing the needs
• Specifying the assessment methods to be used
• Implementation
• Assessing the success of the process
• Stages in the counselling process
Recognizing the need for counselling
• Drug characteristics
• Patient characteristics
• Content of prescription
• Has medicine been prescribed before (PMR / Patient)
• Are instructions clear?
o Chlopropamide 100mg instead chlorpromazine 100mg
• Prescription of drugs with complicated unusual regimen
o Questran sachet 1 t.d.s
o Penicillin V tablets 2 q.i.do Captopril tablet 25mg b.d
Assessing & prioritizing the needs
• Counselling for all patients
• Counselling for OTC products
• Minimal counselling for ‘expert patient’
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• Pharmacist should be selective in what advice is given to the patient (e.g, Vibramycin)
• Counselling at regular intervals for patients with chronic diseases / long term therapy
Specifying the assessment methods to be used
• Don't assume that patient understands all after counselling
• Check patient can read the label• Check patient can use device appropriately
• Check patient can open child resistant container
• Follow-up / next visit inquiry
Implementation
• Appearance & internal environment of pharmacy
• Counselling as professional service
• Pharmacist : organized & clam
• ‘ Ask Your Pharmacist’
Assessing the success of the process
• What does patient understands?
• Do they have any problem?
• Assess compliance
• Watching patient’s body language / maintaining eye contact
Example;
Mrs. Good, an elderly lady of about 75 years, presents a prescription for Diclofenac 50mg tablets.
She has lived alone since the death of her husband, 2 years ago.
When she is signing the back of prescription she has difficulty in holding the pen & complains thather hands & fingers are stiff & hopes that the prescription will help. This is the first time she has
presented a prescription for these tablets