PATIENT COUNSELLING
Patient counselling and chronic disease monitoring are the two important functions performed by the pharmacist. It is the responsibility of the pharmacist to educate the patient about the medication, adverse drug reactions, drug interactions and problems due to non-compliance. Patient education in relation to the pharmacy may be defined as a process that aims at imparting proper drug knowledge, ensuring patient compliance and improved therapeutic benefits.
Definition:
Patient counselling can be defined as an interactive session designed to educate the patient about the medication, by providing him complete information, identifying and removing the barriers which lead to appropriate therapy.
Need for counselling and privacy:
It is a two-way exchange of information between the pharmacist and the patient. The pharmacist has to give information about drugs, their usage in the language that the patient understands. Counselling has to be effective, should be done in a place free of noise, interruption and distractions. Privacy to the patient is of utmost importance.
Classification of counselling:
Patient counseling can be of two types. They are:
1. Direct counselling (Face-Face)
2. Distant counselling ( Over telephone/ through the internet)
Determining patient information needs:
Patients seek information from different sources like physicians, friends, relatives, books or magazines and the internet. A pharmacist should identify the desire of the patient, information seeking behavior, patient-specific needs and then tailor the educational approach to patients counselling.
Patient learning and behavior:
Understanding of attitude and health beliefs of patients is important for designing an effective counselling session. It should be easy to understand and the patient should be able to recall the information and be motivated to follow the treatment regimen.
All the drug-related information should be provided to the patient.
1. Medicine’s generic name, brand name
2. Dose, dosage schedule and route of administration
3. Frequency and duration of therapy
4. Indications to be followed
5. Special precautions
6. Possible side effects
7. Storage conditions
8. Expiry date
9. Cost of the medicine
10. Drug interactions
Selection of the patients for counselling:
Patients are selected according to the need. Some patients require counselling for a few minutes while others take more time. Patient counselling can also be performed during ward round or during the administration of the drugs. Long counselling sessions are given to
1. Patients with long-term diseases/treatment. Ex: Epilepsy
2. Patients without severe symptoms. Ex: TB
3. Patients using drugs with narrow therapeutic index Ex: Warfarin
4. Patients with a danger of abrupt therapy cessation. Ex: Corticosteroid therapy
5. Patients with potential for non-compliance, abuse or misuse of drugs. Ex: treatment with tranquilizers.
Components of patient education:
Patient education programmed should be designed in a manner that the patients understand that they are suffering from ailments that need attention. A good counselling program includes
1. Relevance: The counselling process should be relevant to the needs of the patient. It should be taken into account that the knowledge level, reading level, beliefs, circumstances and prior experience.
2. Individualization: Programme should be according to the individual needs of the patient as every person has his own problems and capacity for learning
3. Feedback: Getting a response from the patient which helps to assess the degree of understanding by the patient about the information given.
4. Reinforcement: Giving the reward to the patient by praising him.
5. Facilitation: It includes new methods to reduce barrier to a treatment regimen and can be done by using special containers, reducing the cost.
6. Combination: Usage of all the above techniques.
Methods of providing the patient education:
1. Verbal education: Direct method of providing education in which two persons are involved
2. Written information: Package inserts (leaflets) found inside a drug package, labels on cartons of drugs, booklets and special promotion material developed by pharmaceutical companies.
3. Audio-visual methods: Involve use of overhead projectors, slide projectors to improve knowledge and increase retention.
Technique of providing patient counselling:
Counselling should be designed in such a way that any message sent by patient, whether verbal/non-verbal should be easily detection by the counselor. There are number of obstacles present in a counselling session and these barriers should be overcome to have a successful session.
Some of the barriers are:
1. Hospital environment: Should be suitable for counselling privacy.
2. Language barrier: Poor people cannot understand English, other languages, technical terms
3. Education level: The patient may not be able to read the label or written instructions or information given.
4. Disabilities of body: Old age people with eye sight inability to hear cannot read or hear the instructions clearly.
5. Patient motivation: If the patient does not listen and learn to the pharmacist, the counseling goes useless.
6. Inadequate time or training: Experienced clinical pharmacists are assigned to the duty of patient counselling. If juniors are assigned, it may affect the quality of counseling.
Rules for designing a good counseling session:
1. Dress formally and sit properly for developing a professional image.
2. Having an eye contact with patient and avoid staring.
3. Establishing rapport with the patient by introducing himself and shaking hand.
4. Counsel with predetermined plan which include more number of open ended questions.
5. Counsellor should have clarity of speech and patience.
6. Session should be ended gradually and ample time should be given to the patient to express and clear his doubts.
Counseling regarding the proper use of drugs:
1. Before using the drugs: Ask regarding allergic conditions, if any. Drug sensitivity, major disease like diabetes, hypertension, renal failure or liver impairment. If pregnant/ breastfeeding.
2. Storage of drugs: Keep away from children, storing in cool dark place, preventing liquid medicines from freezing, discarding expired drugs. In case of single dose injectables -discard remaining drug
3. Proper use: About dosage form, dose, schedule, directions and precautions.
Documentation:
Every step of counselling process should be documented after each counseling session with the patients.