PATIENTCOUNSELLING

Asst Prof Rajmeet Singh

• Patient Counseling is defined as
providing medication information
Orally or in written form to the
patients or their representatives
on:
– directions of use
– on side effects
– precautions
– storage
– diet
– life style modifications.

Bhujbal Knowledge Centre

Toll free: 1800220234 | www.met.edu
• During counseling, the pharmacist should assess patient’s
understanding about his or her illness & the treatment, &
provide individualized advice & information which will assist
the patient to take their medications in the most safe and
effective manner.
• For this, the pharmacist should be familiar with the
pathophysiology and therapeutics of the patient’s diseases.
•Good communication skills are required to gain the patient’s
confidence & to motivate the patient to adhere to the
recommended regimen.
• Improved quality of life of the patients.

• Should ensure better patient compliance.

• The pharmacist should be perceived as a professional who

offers pharmaceutical care

Bhujbal Knowledge Centre

Toll free: 1800220234 | www.met.edu
• Pharmacist is the ideal person to counsel the patient as he
serve as the link between the patient and the doctor.
• Throughout the world, over the past four decades, there has
been a consolidated effort to shift the concept of pharmacy
practice from its earlier focus on medicine supply to patient
care.

Doctor Pharmacist Patient

Bhujbal Knowledge Centre

Toll free: 1800220234 | www.met.edu
• In 1996, for the first time, a separate patient center was
established in the Govt. Medical College, Trivandrum.
• A team of five young comprising of one M.Pharm, one
B.Pharm and Diploma pharmacists lead the counseling
activities.
• It was started in a humble manner with a table, few chairs
and certain essential reference books.
• Within a short period, people found the services of the
center much useful and beneficial for the right use of
medicines.
• Long serpentine queue started appearing in front of the
patient counseling center and by 1997, the center became
a 24 hour service.
PATIENT COUNSELLING
 PATIENT COUNSELLING
 It is instructing the patient about
various aspects of medicines like;
1.How to take?
2.How long to take?
3.What to avoid?
4.Precautions, common side effects,
storage
5.Any other relevant information about
the illness
 PATIENT COUNSELLING
The counseling is also given on issues
like diet, nutrition, alcohol quitting
etc.
 To be successful in patient counseling,
one must have:
1. Friendly approach.
2. Willingness to help customer.
3. Sound knowledge about the drugs/disease.
• The counseling process uses verbal & non verbal communication
skills.
• So, the way in which we speak has an important impact on
patient understanding.

Bhujbal Knowledge Centre

Toll free: 1800220234 | www.met.edu
 PATIENT COUNSELLING: FORMS
□ The patient counseling can be in two forms:
1.Verbal counseling:
Interacting with the patient & talking to
him/her about the matter’s mentioned
above

2.Written instructions:
Giving printed information about the drugs
& disease
• Verbal skills involve:
– Language
– Tone
– Volume
– Speed

• Non Verbal skills involve:

– Proximity
– Eye Contact

Bhujbal Knowledge Centre

Toll free: 1800220234 | www.met.edu
Verbal Communication Skills

•Language:
•When speaking to patients, use
simple language & avoid unnecessary
medical terminology.

•If possible, speak the patients own

language.

Bhujbal Knowledge Centre

Toll free: 1800220234 | www.met.edu
 Verbal Communication Skills

•Tone:
During counseling, the tone of our
voice has a great impact on patient
understanding. The tone of the voice
should be caring and reassuring.

•Volume:
Ideally, counseling should be conducted
in a quiet, private setting where it is
unnecessary to raise ones voice.
Verbal Communication Skills

Speed:
For, good verbal communication, the pharmacist should
present clear, relevant message in a logical sequence, and at
a speed which gives the patient time to think about what is
being said.

This will help the patient understand and remember the

concepts more easily.
Non Verbal Communication Skills

Proximity:
This refers to the distance that people
maintain between themselves during
the counseling process.

Generally, the counselors and healthcare

professionals use personal proximities.

Bhujbal Knowledge Centre

Toll free: 1800220234 | www.met.edu
Non Verbal Communication Skills

Eye Contact:
The amount that people look at one another during
conversation varies depending on whether they are
speaking or listening. For cultural or personal reasons
such as timidity, sadness or depression, some people
avoid looking into the counselors eyes.
 1.Preparing for the
counseling session

Steps 2. Opening of the

counseling session

3. Closing the
counseling session
1. Preparing for the counseling session:

• The success of counseling depends upon the knowledge and

skills of the counselor, the pharmacist should know as much as
possible about the patient and his or her treatment details.

• In the community pharmacy settings, sources of information

includes the patients and their prescription and in some cases,
a record of previous dispensing and medication history for the
patient.
1. Preparing for the counseling session:

• Before counseling, patients state of mind & his physical

state must be known to the counselor.

• If the patient is in hurry, in pain or non communicative, it is

very difficult to counsel the patient effectively.

• In these conditions, counseling schedule may be modified

or postponed to a later date.
2. Opening of the Counseling Session:

During counseling, The pharmacist should gather

information from patients about the following:

•Disease and its duration.

•Drug treatment
•Medications

Bhujbal Knowledge Centre

Toll free: 1800220234 | www.met.edu
2. Opening of the Counseling Session:

•Use of alternative medicines such as ayurvedic,

homeopathic, unani or other system.

•Past medical history.

•Personal habit such as chewing of pan masala, cigarette

smoking and alcoholism.

•Drug allergies
 2. Opening of the Counseling Session:
• During counseling, the pharmacist may best avoid…
• Asking questions in a direct or embarrassing way

• Showing excessive curiosity discussing the patients personal

problems

• Passing moral judgments

• Interrupting when the patient is speaking

• Making premature interpretation and

• Arguing with the patient

 2. Opening of the Counseling Session:

•Counseling Content:
– The counseling content is considered to be the heart of the
counseling session.

– Life style changes such as diet or exercise may also be

discussed.

Bhujbal Knowledge Centre

Toll free: 1800220234 | www.met.edu
 2. O pening of the Counseling Session:

• Topics commonly covered include…

• The name of the medicine
• Removal of drug from package
• Route of administration
• Time of administration
• Duration of use
• Proper storage of drugs
• Allergies
• Side effects
• Drug interactions
• Refill information
3. Closing counseling session:
• Before closing, the pharmacist must check that the patient
has understood what has been communicated to him.
• Before the final closing, the pharmacist should summarize
the main points in a sequential manner.
 Medication Card
•Medication card can be useful aid, particularly for patients on
many medications on a long term basis.
A medication card is a written summary of a patients
• medication, presented in a way which is easy for the patient
to understand.

Pictogram
•Pictogram is a schematic information in the form of simple
pictures, about the duration of use or precautions to be taken
by the patients during the medication.
Patient Information Leaflets (PILs)
•Patient information leaflets are produced by
drug manufacturer for their product are
known as Consumer Product Information
(CPI) or Consumer Medicine Information
(CMI).

• It is a common literature provided with

medicine.

• It bears all information about medicine,

from its chemical nature, its formula up to
its direction for use and dose.
PATIENT COUNSELLING: FORMS
Provide written information only:

1.Notes attached in prescriptions

2.Patients need to be literate
3.Local simple language
4. Severity & frequency of Adverse
reactions may increases without
explanation
PATIENT COUNSELLING
 PATIENT COUNSELLING
POINTS
TO BE ASSESSED IN PATIENT
COUNSELLING:

1.Forgetfulness
2.Lack of confidence & understanding
3.Apathy
4.Health belief
5.Dissatisfaction
6.Non supportive.
 POINTS TO BE ASSESSED
1. Forgetfulness:
 It is very common in case of geriatric
patients.
 Busy and stressful life could be the
reason in case of adults.
 Pediatric patients will always show
their hindrance for taking medication.
 POINTS TO BE ASSESSED
2. Lack of confidence & understanding:
 Patients lose their confidence because
of development of the disease.
 They think they will not be able to
recover from the illness.
 Few people are neither hospitalized nor
have taken any medication in their life.
They may develop a negative attitude
because of this.
 POINTS TO BE ASSESSED
3. Apathy: Patient might develop lack of
interest, enthusiasm or due to
concern
the developed disease.

4. Health belief: People with low

confidence level possess a lot of
negative thoughts about their disease
condition.
 POINTS TO BE ASSESSED
5. Dissatisfaction:
 If positive outcome is not achieved with
the treatment people lose their
confidence with the physician and
pharmacist.

 They start to search a new physician

but will never think that some time is
required for improvement.
 POINTS TO BE ASSESSED
6. Non supportive:
 People are not ready to accept any line
of treatment.
 They are not ready to take any extra
medication for their betterment.
 If they are asked for a follow up visit
after 2 weeks, they will think visiting
after a month will also do.
PATIENT COUNSELLING
ROLE OF P H A R M A C I S T
1. Drug expert & Information
provider
2. Patient helper & Problem solver
3. Counselor & Health promoter.
4. Medication intervener
5. Sensitive to personal problems
of patients
 ROLE OF P H A R M A C I S T
1. Drug expert & Information provider:
 Pharmacist knows about the complete
profile of a drug.
 He can explain the pharmacokinetics
and pharmacodynamics of drug.

 Being a drug expert information

provider
and , pharmacist can explain the
correct use of medications to the patients.
 ROLE OF P H A R M A C I S T
2. Patient
helper & Problem solver:
□Thyroxine tablets prescribed to a
hypothyroid patient must be taken empty
stomach.

 So either it has to be taken early in the

morning or around 4 pm in the evening
which is considered as empty stomach.
 The 1st option could be difficult to
practice, but is ideal.
 ROLE OF P H A R M A C I S T
3. Counselor & Health promoter:
□ Patients suffering from any gastrointestinal
infection are prescribed Probiotics and
antimicrobial agents (AMA) together.
 Probiotics: will replenish the
intestinal and will improve theflora of
digestion
AMA: will take care of the infection
□ If both are taken together at the same
time, it will be of no use.
 ROLE OF P H A R M A C I S T
3. Counselor& Health promoter:
 Duty of a pharmacist is to explain the
patient about this drug-drug interaction
and ask to keep a gap of minimum 2
hours in administration of these two
drugs

This will help to improve the clinical

condition of a patient at a faster rate
 ROLE OF P H A R M A C I S T
4. Medication intervener:
 If a calcium channel blocker and
calcium supplements are prescribed
together, then pharmacist must explain
the importance of both the medications.

 Patient must advised to keep a

sufficient time gap in between their
administration.
 ROLE OF P H A R M A C I S T
5. Sensitive to personal problems of
patients:
 People from lower socio-economic class
may feel the burden of certain prescribed
medication because of money problem.
 Like if AMAs, proton pump inhibitors (PPIs)
and B-complex group tablets are
prescribed together, then they prefer to
buy only PPIs and B-complex group tablet
being relatively cheaper in price.
 ROLE OF P H A R M A C I S T
5. Sensitive to personal problems of
patients:
□ In this case the importance of taking
AMAs as the
needs to explained to the
patient, condition will not be
improved by only PPIs and
taking B-complex group.
 How does counseling help?
 Patient is the end user of the medicines.

 Heshould know the correct use of it, otherwise

the medicines either will not work properly or
may produce adverse effects.

 e.g. Ciprofloxacin tablets & the iron tablets,

Tetracycline & Calcium supplements

 How does counseling help?
 The pharmacist plays an important role
in this Patient education by way of
counseling the patient.

 Counseling increases the involvement of

the Pharmacist & the Patient in the
treatment, patient understands the
importance of taking medicine in a
right way, patient compliance improve
& the treatment becomes successful
PATIENT COUNSELLING
C O M M O N INSTRUCTIONS
 List of common instructions which can
be given to the patient by pharmacists
for most of the medicines:

1. Take the medicine as directed by the

doctor. Do not stop medicines on your
own even if you start feeling better
Consult doctor or pharmacist.
C O M M O N INSTRUCTIONS
2. Complete the entire course of
antibiotics as told by doctor, even if
you start feeling better in one or two
days of the treatment. (Resistance
develops).
3. To gain the most benefit, do not miss
doses. If you do miss the dose, take a
missed dose as soon as possible. If it is
almost time for the next dose, skip the
missed one. Return to your regular
schedule. Do not take a double dose or
extra doses.
C O M M O N INSTRUCTIONS
4. Keep the medicine in its original container
till it is all utilized. Do not cut
tablet/capsule strip till is utilized
completely.

5. Keep all medicine out of the reach

of children and pets.
C O M M O N INSTRUCTIONS
6. Store medicines in cool, dark place
away from heat, sunlight & moisture.
Do not keep at window, in bathroom,
or near stove.

7. If you are diabetic, check your blood

sugar level regularly. If you are
hypertensive, check the blood
pressure regularly.
C O M M O N INSTRUCTIONS
8. Certain drugs should not be used
during pregnancy or breastfeeding,
consult your doctor or pharmacist.

9. Do not share your medicine with others

and do not take anyone else’s
medicine. Avoid Self medication.
C O M M O N INSTRUCTIONS
10. Strictly avoid alcohol while on any
drug therapy as some drugs with
alcohol can produce dangerous
effects.
PATIENT COUNSELLING
 INTERVIEWING SKILLS
 Professional attitude: positive
attitude to diseases/discomforts.

 Questionnaire Tech: Less you say and

let the patients speak more.
 Closed ended: OTC
 Open ended: Tell about the
medication problem etc.
PATIENT COUNSELLING
 BARRIERS TO PATIENT COUNSELLING
Physical barriers:

 Physical positioning of counseling centers

 Lack of privacy

 Uncontrolled sound
 BARRIERS TO PATIENT COUNSELLING

Mental barriers:
 Lack of time
 Lack of confidence
 Lack of knowledge
 Language problem
 Poor perception of pharmacistsby patients
 Fear of infringement in physicians
territory.
 Emotional display of anger & irritation
 Patient Based Barrier
•In India, many patient are unaware that pharmacist may
provide counseling and generally ask their prescriber about
medication use.
• Gender and language differences may also inhibit patient
from asking the pharmacist about medication use
information.
• Many pharmacist lack the confidence to counsel patients
due to lack of knowledge and counseling skills.
• A heavy patient load for prescription filling is also an
important barrier in many practice situation.
System Based Barrier
•In India, counseling is not a
mandatory legal requirement and
officially pharmacist are not entitled
to charge for dispensing or for the
information provided to patients.
•These factors act as regulatory and
financial disincentives to providing a
counseling service.
•Lack of privacy in community &
hospital pharmacies can also be a
problem.
PATIENT COUNSELLING