MODULE ( V)

Tailoring Counseling to
Meet Individual Patient
Needs and Overcome
Challenges
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 Objectives
1. describe the factors that may require the tailoring
of counseling for individual patients.
2. To identify situations presenting special challenges
in counseling.
3. List challenges pharmacists face with patients with
special needs.
4. describe techniques to use to improve counseling
for the elderly, children, disabled, limited literacy,
or critically ill patients.
5. describe techniques to handle difficult issues such
as a medication incident.
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 Factors to Consider in Tailoring
Counseling
1. Patient
2. Drug
3. Condition
4. Situation
5. Pharmacist
6. Pharmacy environment
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Factors to Consider in Tailoring Counseling

1. Patient
Age
Cultural background
Abilities and preferences
Disabilities
Lifestyle and employment
Gender, employment status, socio-economic
status

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Factors to Consider in Tailoring Counseling

2. Drug:
Prescription or nonprescription
Risk level and adverse effects
Route of administration
Time to effect

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Factors to Consider in Tailoring Counseling

3. Condition:
Seriousness
Emotional Factor, e.g., fear,
anger, and embarrassment
Level of lifestyle modification
needed
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Factors to Consider in Tailoring Counseling

4. Situation:
New or returning patient
Conflict or emotional upset
Pharmacy environment, e.g., interruption,
limited time, and privacy
Medication incident
Nontherapeutic concerns, e.g., child abuse
and threat of suicide
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Factors to Consider in Tailoring Counseling

5. Pharmacist:
Knowledge of patient
Knowledge about drugs and
conditions
Communication skills Time
Attitude ‫سلوك‬
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Factors to Consider in Tailoring Counseling

5. Pharmacy Environment:
Lack of privacy
Poor patient accessibility
Lack of time
Isolation from health care team

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COUNSELING PATIENTS WITH
SPECIAL NEEDS

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 Counseling Patients with Poor
Comprehension: low literacy patients
1. Simplify Explanations: simple terms
2. Involve community or care giver.
3. Use Various Counseling Methods and Aids: Assisted
labeling such as pictograms, charts, and clock diagrams
4. Obtain Feedback and Use the Teach-back Technique
5. Follow-up
6. Be Patient But Assertive and Allow Extra Time as
Needed
7. Respect the Individual Patient and His Rights
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 Counseling Patients with Disabilities
1. sensory disability:
– hearing (deaf or hard of hearing)
– sight (blind or visually impaired)
2. physical disability or mobility impairment
3. speech impairment
4. cognitive disability
5. self-care disability

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Tailoring Counseling for Patients with
Disabilities
1. Be Alert for Signs of Disabilities
2. Treat Patients with Disabilities with Dignity
and Respect
3. Be Prepared for Feelings
4. Offer Assistance
5. Allow Extra Time
6. Communicate Appropriately: USE appropriate
words.
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Tailoring Counseling for Patients with
Disabilities…Cntd
7. Involve the Patient and seek Feedback
8. Emphasize Nonverbal Communication
9. Use Appropriate Counseling Methods and Aids.
10.Provide the proper Environment:
– counseling environment should be private, quiet and
well lighted.
– The position of the pharmacist should be as close to
the patient as possible for comfort, on the same level

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Counseling Patients with Critical
or Difficult Conditions

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 1. Patients who are hard of hearing
 Do not yell
 pronounce clearly and face the person directly
 Avoid bowed head
 Use simple sentences and familiar vocabulary to
facilitate lip reading
 Supplement written notes, or charts and diagrams.
 In total deafness, involve a family member or
caregiver.
 Allow the patient to select preferred mode of
communication. e.g., reading lips, writing notes,
interpreter, or telecommunications devices for the
deaf (TDD)
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 2. Patients who are visually impaired
1. Identify yourself and any other people involved.
2. For different medications: Vary the size of
medication containers to help identification.
3. Use bright-colored stickers for patients with
limited vision
4. Use description when giving instructions, e.g.,
take the large, round pill in the tallest container
5. When offering a seat, gently place the individual's
hand on the back or arm of the chair so he or she
can locate the seat
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 3. Patients with mobility difficulties
1. Don't lean on a person's wheelchair
2. Sit or squat down so that you will be at eye
level
3. When telephoning the patient, allow the
phone to ring longer than usual to allow the
patient time to reach the phone

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4. Patients with speech difficulties
1. Concentrate on what the individual is saying
2. Do not speak up for the individual or attempt
to finish sentences
3. If you don't understand, do not pretend to
understand, but ask the patient to repeat or
ask the patient if writing is an alternative

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 5. Dealing with patients with
cognitive disabilities

1. Move to a quiet or private area free

of distractions
2. Be prepared to repeat instructions
3. Be patient and flexible

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 Counseling Elderly Patients
• Issues in Counseling Elderly Patients:
1. High Drug Use: 30% of all Rx & 40% of OTCs.
2. High Incidence of Illness: 80% has at least one illness.
3. Increased Risks of Drug-related Problems (DRPs) and
Inappropriate Drug Use.
4. Increased Limitations and Disabilities
5. Decline in Cognitive Functioning
6. Difficulties Adhering to Medication Regimens
7. Attitudinal Barriers to Communication: Pharmacists may
view elderly patients in a stereotypical way.
8. Literacy and Cultural Issues
9. Access and Affordability to Health Care Services: drug cost
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 Counseling of Geriatric Patients
• According to the „GUIDELINES FOR PHARMACIST
COUNSELING OF GERIATRIC PATIENTS” the pharmacist
should focus on the following:
Pharmacists should possess the following knowledge and
skills to effectively counsel the geriatric patient:
1. Current knowledge of geriatric pharmacotherapy and
aging
2. Knowledge of the geriatric patient’s culture and
attitude toward health and illness
3. Awareness of patient’s sensory or cognitive
impairments
 Tailoring Counseling for Elderly
Patients
1. Recognize Feelings and Attitudes toward Aging
2. Conduct Regular Medications Reviews and Be
Alert for Drug-related Problems(DRP).
3. Educate Elderly Patients about Self-monitoring:
B.P, Diabetes..etc
4. Allow Time: build personal relation
5. tolerate elders Disabilities

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 Tailoring Counseling for Elderly
Patients..Cntd
6. Provide Follow-up: especially for patients who
live alone
7. Provide Privacy
8. Emphasize Adherence: offer compliance pk.
9. Select Appropriate Counseling Methods and Aids
10.Involve relatives, Caregivers and Community
Supports
11.Offer or initiate home visits.

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 Tips for Counseling Elders
1. Establish a relationship by demonstrating genuine
interest and acceptance.
2. Address people using their preferred name.
3. Introduce yourself as a pharmacist, explain the purpose
and expected length of the session.
6. Provide information orally and use visual aids or
demonstrations to fill the patient’s gap in knowledge and
understanding.
7. Show the patient the colors, sizes, shapes, and markings
on oral solids. For oral liquids and injectables, show
patients the dosage marks on measuring devices.
8. Demonstrate the assembly and use of administration
devices such as nasal and oral inhalers.
 Tips for Counseling Elders

9. Use active listening skills, good eye contact, and

gestures where appropriate.
10. Observe nonverbal cues such as body language,
behavior or facial expression, for reactions. Give
support, encouragement and feedback.
11. Assess the patient’s knowledge about health
problems and medications. If a patient is
experiencing problems with the medication, gather
appropriate data and assess the problems (DRP)
 Tips for Counseling Elders
12. Use open questions to gather information and assess
his hearing and cognitive abilities.
13. Notice nonverbal signs of not hearing (confusion,
turning head so ear is closer, cupping ear) or of
cognitive impairment (look of confusion, talking
about unrelated topics).
14. Ask directly if you are speaking loud enough and ask
for feedback on information provided.
15. Provide a chair for him to sit in while waiting and
during consultation.
16. Provide written information for him to read over for
better comprehension
 Counseling Elders case & questions

• An elderly gentleman comes to the

pharmacy to ask for a cane. Just by
looking at him, you suspect that he
may also have hearing or cognitive
impairment. What type of bias
would you be exhibiting?
 Counseling Elders case & questions

• Age bias: assuming elderly

have hearing or cognitive
impairment. (stereotypical
bias)
 Counseling Elders case & questions

• How would you determine if the

gentleman in the previous question
has these disabilities? How would
you tailor counseling to allow for this
and his need for a cane when
counseling him for his medications?
Communicating with Children
About Medicines
 Why different than adults
communication
1. Communication with children typically
involves three people: the pharmacist, the
child, and the parent of the child
2. Communicate at a level that is appropriate
for the child cognitive level.
3. Children do not receive much education
about medicines from physicians or
pharmacists
 Communicating with Children About
Medicines
• Communication with children and adolescents (USP
Guiding principles)
1. Children have a right to appropriate information about
their medicines
2. Children want to know.
3. Children’s interest in medicines should be encouraged.
4. Children learn by example. The caregivers should show
them appropriate use of medicines.
5. Children, their parents should negotiate the gradual
transfer of responsibility.
6. Children should receive basic information about
medicines and their proper use.
How and When to Communicate With
Children of Different Ages?
• According to Piaget’s cognitive development
theory, thinking develops through different stages
from infancy through childhood to adolescence
1. The stages are sensory motor stage (birth to 2
years);
2. preoperational stage (2 to 7 years);
3. concrete operational stage (7 to 12 years);
4. Formal operational stage (12 years to
adulthood).
 How and When to Communicate With
Children of Different Ages? Example how to discuss with children at different
Stage (age, years) Typical features stages about medicines
Sensory Little connection to objects outside the self. No learning about medicines can occur
motor (0–2)
Pre- operational Cannot understand cause and effect Considers only Avoid yes/no questions
(2–7) single aspect of a situation Ask about previous experiences (egocentricchild
Magical thinking predominant Egocentricity is pleased to tell you)
Wants to please the adult and answers readily Discuss any concerns the child raises about the
“yes” to questions previous experiences of medicine use, e.g., bad taste
Give only 1–2 messages, without cause and effect
explanations
Concrete Thinking becomes logical and systematic Explain the purpose of each medicine the child needs
operational (7– Can understand cause and effect, and multiple to use, e.g., an asthmatic child who needs to use
12) aspects of a situation control and relief medicines
Can solve problems Use concrete examples when explaining medicine
Thinking is still very concrete and based on own use to the child
experiences
Formal Capable of hypothetical and abstract thinking Concrete patient counselling as to adults
operational (12– Typical for adolescents: Be nonjudgmental, keep discussion confidential
) Counsel in private place Remember that
Invincibility fable: feeling that one will never be adolescents may be embarrassed easily, even when
harmed. discussing very common medicines such as
Falsely secure in the belief in own immunity which painkillers.
explains a lot of teen risk taking. Explain carefully that the questions you ask are
Personal fable: belief that own life and feelings are necessary to help you choose the correct medicine.
unique. Notice! adolescent may be inexperienced in how to
Imaginary audience: typical fantasies about how behave in a pharmacy
others react to one’s appearance and behaviour.
 Case of Concern
• A father picked up an oral antibiotic suspension
prescription for his son who had a severe
infection. Due to the relatively high dose of the
antibiotic and the need for a longer period of
treatment, the father was given two bottles of
antibiotic and was told to give 1 teaspoonful
twice a day. When he reached home, he gave his
son 1 teaspoonful from both bottles. Fortunately,
the mother questioned this approach once she
realized what was going on, called the pharmacy
for clarification, and continued therapy at the
appropriate level.
 Communicating with Children About
Medicines
1. Health care providers should communicate
directly with children about medicines.
2. Children's interest should be encouraged,
and they should be taught how to ask
questions about medicines and other
therapies.
3. Counseling children should respect:
a) parental responsibilities and
b) the health status and capabilities of the child.
 Counseling of Hearing Impaired

• Eliminate as much background noise as possible.

• Determine if the patient wears a hearing aid and that it is
present and functioning.
• Augment oral communication with other methods, e.g.,
writing, pictures, signs, and gestures.
• Face the person directly to achieve eye contact and enable
lip reading.
• Do not cover your mouth or turn away when speaking.
• Speak slowly and clearly without exaggeration or shouting.
• Evaluate understanding frequently and rephrase if
necessary.
• Focus on the main subject without unnecessary detail
 Counseling of Visually Impaired

• Determine if patient wears glasses, contacts or other visual

correction device.
• Position what needs attention so that it is in the center of the visual
field.
• For printed communication, use black printing on white or off-white
paper and larger font sizes.
• Be creative about methods of communicating, including talking
books, radio and tapes.
• Speak as you approach the person so that he/she knows you are
there. Introduce yourself and use touch, if the person does not
object.
• Sit at the same level, and face them during the conversation. Give
clues to relevant aspects that they may not be able to see.
 Counseling of Cognitive impairment

• Gain the patient’s attention.

• Address one topic at a time.
• Give simple, relevant information.
• Allow the patient to feel in control. Manner, tone
of voice, and body language can convey power
and authority.
• Use a calm matter of fact approach, with clear
and distinct verbal communication.
• Adapt to disease related language and memory
deficits.