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PHARCARE 4: DISPENSING AND MEDICATION COUNSELING

AY 2018-2019 First Term


Unit 1 Handout

UNIT 1: INTRODUCTION: THEORETICAL PERSPECTIVES & CONTEMPORARY


ISSUES ON DISPENSING & PATIENT MEDICATION COUNSELING

I. INTRODUCTION
Pharmacists

• Are experts on the action and uses of drugs:

– Chemistry of drugs
– Formulation of medicines
– Drug usage to manage diseases

• Are often in close contact with patients


– Assist to the best use of the medicines
– Advise on matters concerning health

– Supply medicines for use with minor conditions


• In close working relationships with other members of the health care team – doctors,
nurses, dentists & others.

• Give advice on issues surrounding the use of medicines


• Employed in many different areas of practice
– Hospital

– Community
– Academia
– Pharmaceutical advisor

– Community facilitator
– Pharmaceutical industry

II. CONTRIBUTION OF PHARMACY TO TODAY’S HEALTHCARE PROVISIONS

A. COMMUNITY PHARMACY

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PHARCARE 4: DISPENSING AND MEDICATION COUNSELING
AY 2018-2019 First Term
Unit 1 Handout

a. Original Pack Dispensing

– ORIGINAL PACKS - pharmaceutical packs commercially produced & intended


for finite/limited treatment periods
– Dispensed directly to the patient in their original form.
– Manufacturer’s information is contained on the pack but the pharmacist must attach
a dispensary label.
– Welcomed by the profession.
– There are regular calls for manufacturers to be more proactive/practical in
introducing the packs which have potential benefits for the patients & pharmacists.

b. Increasing Use of Computers for Patient Medication Records (PMR)

– Used during dispensing a prescription


– Confirms the prescriber & that the name & address on the prescription & PMR
match
– Checks safety & appropriateness of each item against the data on file, including
drug interactions & any recorded contraindications & allergies
– Checks doses
– Efficient way of checking the safety of the Rx for the patient.
– Improves efficiency of service:
• Frequency of counseling
• For generic medicines dispensed, the source is recorded
• Helps if errors are made of if information is missing from a repeat
prescription

c. GP-Pharmacist Links

– Doctors realized pharmacists had many possible additional roles, and they made
use of their services.
– Recently, in the extension of clinical pharmacy into the community, the
pharmacists:
• provide doctors advice on formulary development.
• undertake patient medication reviews.
• take responsibility for specific clinics following agreed protocols

d. Responding to Symptoms

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PHARCARE 4: DISPENSING AND MEDICATION COUNSELING
AY 2018-2019 First Term
Unit 1 Handout

– Provision of advice on appropriate purchase of OTC and pharmacy medicines for


symptomatic relief of minor illness and common complaints is now an accepted
part of the work of a pharmacist.
– Also extended to the counter staff, who require special training & must adhere to
protocols.
• Skills required: observation, questioning & decision making.
– Distinguish between major & minor illness.
– Special considerations with children, the elderly, pregnant & breastfeeding women
& patients with chronic conditions.

e. Patients with Special Needs

– Aids patients to comply with & maximize the benefits of their medicine
regimen (important contribution of pharmacy to health care).
– Patient compliance – extent a patient takes or uses his medicine in accordance
with the directions /follows the doctor’s general health advice.
– Pharmacist ensures patient has enough information in an understandable form.

f. Domiciliary Services (Hospital at Home)

– Pharmacists make regular visits to residential homes on situations where


patients have:
• special needs
• during terminal care
• for parenteral feeding.
– helps patients to comply with drug regimen/ specialized services on:
• palliative care
• cytotoxic agents
• IV antibiotics
• artificial nutrition

g. Health Education

– Limited to the provision of a range of leaflets (ex. Diet to reduce the development
of disease)
– relatively few examples of extensive health promotion in pharmacies.

B. HOSPITAL PHARMACY

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PHARCARE 4: DISPENSING AND MEDICATION COUNSELING
AY 2018-2019 First Term
Unit 1 Handout

a. Clinical Pharmacy Service


– For the achievement of:
• better patient care.
• financial savings through cost effective use of medicines.
• improved use of pharmaceutical expertise.
– 2 main components identified with the hospital service in response to clinical
pharmacy service:
1. Overall management of medicines on the hospital ward
- Achieved through the provision of advice to medical & nursing
staff, formulary management & ensuring the safe handling of
medicines.

2. Development of individual patient care plans


- Achieved through the provision of drug information and assisting
patients with problems which may arise.

b. 24-hour Service

– Available in most large hospitals, with a pharmacist on call.

c. Increased Research

– Research in hospital pharmaceutical service.

d. Development of Specialized Services

– Pharmacists are involved on the use of:


• cytotoxic drugs.
• Radiopharmaceuticals
• parenteral nutrition (both in hospital & at home).
• centralized IV additives services.
• various types of dialysis.

C. PHARMACY EDUCATION

a. Restructured B.S. Pharmacy Program

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PHARCARE 4: DISPENSING AND MEDICATION COUNSELING
AY 2018-2019 First Term
Unit 1 Handout

– some changes to pharmacy course produce not only competent pharmaceutical


scientists, but also graduates with a knowledge of practice:
– use of practitioners, restructuring of subjects, introduction of new materials

b. Continuing Education

– continual updating of knowledge:


• Pharmaceutical Journal
– Innovative approaches:
• GPs & pharmacists receive continuing education together
– helps to break down the barriers between professions & increases mutual
understanding of knowledge & expertise

c. Higher Degrees

– MSc degrees, distance learning courses, PhD in pharmacy.

d. Research

– in pharmacy practice. “Publicize the findings.”

III. “PHARMACY IN A NEW AGE” : IDENTIFIED 4 AREAS OF CONTRIBUTION


TO HEALTH CARE

A. The Management of Prescribed Medicines


– drug development.
– provision of medicines, information and support.
To ensure patient needs are met safely, efficiently and conveniently to get maximum
benefit from their medicines.

B. The Management of Chronic Conditions


– supplying medicines and advice.
– helping to develop local “shared care” protocols.
– by ensuring patients are taking their medicines properly.
– helping to improve the outcomes of treatment.
To improve QOL of the patient.

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PHARCARE 4: DISPENSING AND MEDICATION COUNSELING
AY 2018-2019 First Term
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C. The Management of Common Ailments


– reassurance and advice
– referral to other professionals if necessary

D. The Promotion and Support of Healthy Lifestyle


– helping people protect their own health through:
• health screening,
• giving advice on healthy living,
• providing educational materials

Extended Role of Pharmacist

– professional audit/assessment
• a tool to improve the quality of service provided by pharmacy

– use of guidelines and protocols

IV. PROFESSIONAL PHARMACY PRACTICE

A. STRUCTURE AND ORGANIZATION OF PHARMACY

a. Pharmacist

The trusted healthcare professional that is given the responsibility for safe-guarding
and supplying medicines to the individual patient within the legal system of a
country.

b. Global Organizations
World Health Organization (WHO)
• Directing and coordinating authority for health within the United Nations

• Developed the model for essential medicines list


International Pharmaceutical Federation (FIP)

• Global federation of national pharmacy associations

c. Pharmacy in the Philippines

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PHARCARE 4: DISPENSING AND MEDICATION COUNSELING
AY 2018-2019 First Term
Unit 1 Handout

– Professional Regulation Commission


• Council of Pharmaceutical Eduation
• Board of Pharmacy

– Philippine Pharmacists Association (PPhA)


– Department of Health
• Essential medicines List or national drug formulary
– Food and Drug Administration
– Professional pharmacy organizations
• Community Pharmacists Association of the Philippines (CPAP)
• Philippine Society of Hospital Pharmacists (PSHP)
• Philippine Association of Pharmacists in the Pharmaceutical Industry
(PAPPI)
• Philippine Association of Pharmacists in the Veterinary Industry (PAPVI)
– Pharmacy roles
• Community pharmacist
• Hospital pharmacist
• Industrial pharmacist
• Veterinary pharmacist
• Pharmacy educators
• Regulatory pharmacist
• Government pharmacist
• Corporate pharmacist

B. RELATIONSHIP WITH OTHER HEALTHCARE TEAM MEMBERS

a. Healthcare Team

Teamwork is the process whereby people work together cooperatively to deliver


goals.

Requires skills:
▪ Listening Skills
▪ Questioning Skills
▪ Respect
▪ Helping
▪ Sharing
▪ Collaborating

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PHARCARE 4: DISPENSING AND MEDICATION COUNSELING
AY 2018-2019 First Term
Unit 1 Handout

▪ Communication

❖ The Community Pharmacist relates with


▪ Dispensing/Pharmacy assistants
▪ Physicians, dentists and other licensed practitioners
▪ Government officials and employees

❖ The Hospital Pharmacist relates with


▪ Pharmacy team
▪ Healthcare professionals involved in patient care
▪ Hospital administration, professional and administrative staff
▪ Community pharmacists

❖ Dispensing / Pharmacy Assistants


▪ Works under the supervision of the pharmacist.
- Works under the supervision of the pharmacist.
- Sale of OTC medicines and provision of info to customers
on symptoms and products
- Prescription receipt and collection
- Assembly of prescribed items
- Ordering, receiving and storing pharmaceutical stocks
- Preparation of materials for compounding

▪ Legal basis: RA 10918 (SB 3140)


“Pharmacy Assistants" are persons who assist pharmacists in
compounding and dispensing of medicines in community, hospital,
industrial settings and in other activities, such as, but not limited
to medical missions, under the supervision of the pharmacist.
Pharmacy aides and clerks are those who assist in other aspects
of pharmacy operation.”
▪ Persons handling drugs other than the pharmacist are:
1. Pharmacy owners who are not registered pharmacist,
2. Professional medical representatives,
3. Pharmacy assistants,
4. pharmacy aides/clerks,
5. and other persons who assist pharmacists in dispensing
medicines or any other person performing functions
involving the handling of drugs and drug products.

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PHARCARE 4: DISPENSING AND MEDICATION COUNSELING
AY 2018-2019 First Term
Unit 1 Handout

▪ IRR of RA 10918 (SB 3140) – It is preferred that these positions are


occupied by those who finished pharmacy degree, not necessarily
licensed as pharmacists, and who have undergone the prescribed
training from a Commission-accredited provider.

❖ Pharmacy Technician
▪ Make up prescriptions issued by doctors.
- Reading prescriptions and translating doctor’s instructions
- Counting solids and measuring liquids
- Prepare accurate labels for medicines
- Selling medicines and complementary preparations
- Referring to pharmacists when appropriate
- Small-scale or individual preparation of extemporaneous products
- Maintaining and managing stock within the pharmacy
- Record-keeping and audit
- Being aware of legal requirements relating to prescribing and supply
of medicines

b. Role in Teamwork
Essential Skills:
• Leadership,
• Delegation and
• Negotiation

C. CONCORDANCE
occurs when the patient and the healthcare professional participate as partners to
reach an agreement on when, how and why to use medicines, drawing on the
expertise of the healthcare professional, as well as the experiences, beliefs and
wishes of the patient (Marinker et al, 1997)

a. Three essential elements:


1. Includes an explicit agreement between two people
2. Is based upon respect for each other’s beliefs
3. Gives the patient’s view priority although they may choose to have the
professional make all the decisions about the treatment

b. Evidence for Concordance

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PHARCARE 4: DISPENSING AND MEDICATION COUNSELING
AY 2018-2019 First Term
Unit 1 Handout

1. Eliciting the patient’s view


- Individual patients will vary in their confidence in the medicine to help
them
- Patients may believe that they will become “immune” or addicted to a
medicine if they take it long term
- Many consider prescribed or over-the-counter medicines, particularly in
comparison with herbal products, to be unnatural, artificial and
potentially harmful

2. Developing rapport with the patient


- Active listening
- Avoiding jargon
- Using open questions
- Appropriate body language
- Encouraging patients to ask questions
- Treating patient as equal and being non-judgmental
- Empathy

3. Providing information
- Information should be provided in a manner which takes account of
what the patient may already know and what, and how much,
information they would like to receive.
- Verbal information can be supported with written information like the
patient information leaflet (PIL).
- Decision aids may also be used.
- Criteria used to judge quality of information provided:
a. Information accuracy, comprehensiveness and reliability
b. Clarity of aims and target audience
c. Comprehensibility and balance of the information
d. References to sources
e. How up-to-date it is
f. Support for shared decision-making
g. Transparency of authorship and sponsorship (if any)
- Providing Information (Communicating risk)
• To provide information on the effectiveness of a medicine or the
likelihood of a side-effect occurring
• Use of both verbal or text information and numerical or graphical
information on risks can aid patient understanding

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PHARCARE 4: DISPENSING AND MEDICATION COUNSELING
AY 2018-2019 First Term
Unit 1 Handout

• Absolute-risk information is the preferred method for conveying


accurate risk information.

4. Therapeutic alliance

c. Concerns About Concordance

Four Issues:

1. Time
- Practice makes for efficiency
- Address patient issues openly
- De-couple the provision of information about option from the constraints
on consultation length

2. Anxiety
- Present information on both positive and negative effects of treatment, in a
manner understandable to lay people, that links into lay theories of illness
and treatment and which promotes informed choice

3. Participation
- People need to be involved in decision-making to the extent that they want
to be. The best way to do this is to ask them.

4. Demands
- Concordance is about both parties expressing their views and if a healthcare
professional has reservations about a certain treatment option, he needs to
explain the rationale to the patient.

REFERENCE: Rees, JA, Smith, I and Watson, J. (Ed.) (2014). Pharmaceutical Practice 5th Ed.
Churchill Livingstone Elsevier: China. pp.121-133, 163-172.

V. SOCIO-BEHAVIOURAL ASPECT OF PHARMACY

• Behavioral Science
– the scientific study of human behavior

• Psychology

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PHARCARE 4: DISPENSING AND MEDICATION COUNSELING
AY 2018-2019 First Term
Unit 1 Handout

– studies human behaviour


– understand the patient’s response to illness and treatment and relationships between
doctors, pharmacists, patients
• Sociology

– explains an individual’s actions and relates this to the society in which he lives
– concerned with relationship between society and the individual which influence the
experiences of health and illness

– includes the way individuals respond to health and illness and to other people
– Helps the pharmacist to meet patient’s needs

• WHO defines health as “a state of complete physical, mental and social well-being”.

– An understanding of health as a social concept will help us appreciate who will be


most likely to seek help from the pharmacist when they suffer from symptoms and
also has implications for implementing effective strategies on health promotion and
education.

– “Disease is something an organ has : illness is something a man has” (Helman,


1981)

• Symptom Iceberg

– symptoms not reported to healthcare professionals

• Action in Response to Symptoms


– taking no action

– consulting family or friends


– taking medicine already at home
– buying OTC remedy

– seeing a doctor/dentist

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PHARCARE 4: DISPENSING AND MEDICATION COUNSELING
AY 2018-2019 First Term
Unit 1 Handout

• What makes a person decide to seek help from a healthcare professional?

• Illness Behavior
– concept used to describe the steps that people go through in order to decide that
they are ill
– visit a doctor or pharmacist
– for: therapeutic benefit and recognition of the sick role

• Help-seeking behavior
– lay referral system
– network of colleagues, relatives and friends
A person is likely to consult a health professional when the perceived benefits outweigh
the perceived costs.

• Health Belief Model


– brings together all the demographic and psychological factors which will influence
an individual’s assessment of costs and benefits involved in seeking help

• Health motivation
– the level of interest an individual express in health issues

• Susceptibility

– the individual’s perceived vulnerability to illness

• Severity
– the perceived seriousness of certain illnesses

• Benefits and Costs


– the perceived value of taking health actions

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PHARCARE 4: DISPENSING AND MEDICATION COUNSELING
AY 2018-2019 First Term
Unit 1 Handout

• Use the model to assess perceptions and identify ways

– in which behavior can be changed (assuming that people


– will follow the advice of a healthcare professional about behavior change)

People often seek help from a pharmacist before seeking doctor’s help.
Pharmacists

– have an important potential impact to make on the symptom iceberg


– help to treat the minor, self-limiting symptoms and refer the more serious symptoms
to the doctor

– source of help advice


– treat minor ailments

– readily available and accessible


– reassure people to visit a medical practitioner
– thereby sanctioning the initial transition to a sick role

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