1. PATIENT COUNSELLING

2. 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

3. 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

4. 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

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

6. 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)

7. 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

8. 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

9. Communication skills important for effective counselling
Verbal
Language
Tone
Volume
Speed

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

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

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

13. 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

14. 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

15. 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

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

17. 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

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

19. 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

20. 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.

21. 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 ?

22. 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

23. 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

24. 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

25. 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 ?

26. 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.)

27. 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

28. 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

29. THANK YOU -PHARMA STREET