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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



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



• 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



• 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’



• 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

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