PATIENT COUNSELLING

TOPICS Understand the need for patient counselling Identify outcomes of effective patient counselling What are various communication skills needed Steps in this process Which patient group needs most counselling

What is patient counselling Providing the following to patients Information Advice Assistance WHY is patient counselling needed ?: So that patient use their medication properly Safe & Effective drug-therapy depends on patient being well-informed about their medication

What is patient counselling Understand patient illness & medications prescribed Personalized advice on taking medications Provide advise to lifestyle change This is done to ensure that medications taken with be SAFE & EFFECTIVE

effective patient counselling Effective Patient counselling REQUIRES Understand disease, pathophysiology Pharmaco-therapeutics Effective communication skills

Current state in india Treatment of patients at Primary. Secondary & tertiary levels Drug prescribers (Doctor’s) are overloaded, Have no time for patient counselling, advice on how to take medication Patients on not clear on how to use medicines (when to take, how long to take, what to do when missed etc)

Effect of lack of counselling Patients on not clear on how to use medicines (when to take, how long to take, what to do when missed etc.) This results in Therapeutic failure Adverse events Avoidable additional treatment & cost

Effective counselling will result in .. Better patient understanding of their illness Role of medication in treating illness Improved compliance/adherence Reduced incidence of adverse events (AE) Improved quality of life Better strategy for patients to handle drug related AE

Communication skills important for effective counselling Verbal Language Tone Volume Speed

Communication skills important for effective counselling Verbal Language Tone Volume Speed Simple, easy to understand Avoid medical jargon Prefer patient own language

Communication skills important for effective counselling Verbal Language Tone Volume Speed Tone tells a lot about the person speaking Caring, assuring

Communication skills important for effective counselling Verbal Language Tone Volume Speed Stable volume Avoid high volume Ideally in a quiet setting

Communication skills important for effective counselling Verbal Language Tone Volume Speed Rate of speech should be moderate Clear message in a logical sequence This helps patient understand what is being said

Communication skills important for effective counselling Body language (movement of hands, limbs etc.) Dressing Non-Verbal Distance Eye contact Facial expression Did you know: almost 50% of message is received in NON-Verbal manner

Communication skills important for effective counselling Patient Non-Verbal Distance Eye contact Facial expression Private <= 45 cm Personal 45 – 1.2 m Social 1.2 – 3.6 m Public > 3.6 m

Communication skills important for effective counselling Non-Verbal Distance Eye contact Facial expression Patient sensitive to eye contact Cultural issues matter

Communication skills important for effective counselling Non-Verbal Distance Eye contact Facial expression Can be used to show empathy Head, hand movements can be used to signal empathy as well Empathy: The ability to identify with or understand another's situation or feelings

Steps during counselling Preparing for session Opening the session Actual Counselling session Closing the session

Preparing for counselling session Success of session depends on Skill & Knowledge of pharmacist Through review of patient medical history, medication records Different sources can be used such as Hospital records, community pharmacy drug dispensing records Pharmacist needs to have a good understanding of pathophysiology & drug that are prescribed References such as “Drug Information Reference” should be consulted before hand

Opening the session At start of session, focus on information gathering from patient Introduction from pharmacist, make the patient comfortable Greetings followed by intro & state objective of meeting Seek information from patient regarding his medication, understanding of his disease Other supplementary information such as ; previous allergies, past medications, smoking, alcohol history etc.

Opening the session How to get information from patient: Open ended questions helpful. Q on patient understanding of disease: What symptoms are you experiencing ? What did your doctor tell you about the disease ? Q on patient understanding of his/her medication: What did your doctor tell you about this medication ? Reflective Questions also help Did these tablets help you last time, did you feel better ?

Opening the session Be aware of patients mental state, does he/she want to talk ?? Try to empathize with patient, speak in a reassuring tone Avoid being aggressive, personal, intrusive questioning If the patient is getting aggressive, stop the session

Counselling content The main part (Heart) of session Pharmacist speaks about medication & lifestyle changes Typical topics covered Name/Strength of drug How long, how to be taken Expected benefits, time frame Possible side effects Possible interactions What to do if missed dose Special monitoring requirements

Counselling content The main part (Heart) of session Pharmacist speaks about medication & lifestyle changes Counselling in simple language Medical jargon should be avoided In some cases, the advice given to family members

Closing the session This usually done by asking simple questions Before ending, important to know patients understanding of his medication This usually done by asking simple questions Example: Which is the blood pressure drug, how many will you take in a day , which one after meal ?

First timers Advisable to listen to sessions by senior pharmacists Getting confidence for young pharmacist is important before session Advisable to listen to sessions by senior pharmacists Start with limited counselling sessions Develop expertise in one area & then move to other (Antibiotics etc.)

Prioritize counselling Most of the time, pharmacist are too busy They need to prioritize which category of patients to counsel typically the focus groups are Special medication group Complex medication (TB, HIV regimens) Specialized delivery drugs (Rotahalers) Elderly patients on many drugs (polypharmacy) Special medication group_ narrow TI, antibiotics etc

Counselling aids Develop teaching, educational aids In addition to live counselling Good for follow up reading by patients Medication card : useful aid, has summary of drugs Easy format, patient can understand Pharma companies draft “Consumer Product Info” Pharmacist can also draft simple product info

THANK YOU -PHARMA STREET