PATIENT

MEDICATION
COUNSELING
OBJECTIVES
:
1.) To define & discuss patient
counseling.
2.) To explain the goals of
counseling.
3.) To discuss the essence of the
educational goals of patient
counseling.
The meaning of counseling

Pharmacy Student: What is

patient counseling, anyway?

Pharmacist A: Patient
counseling is giving advice to
patient.
Pharmacist B: Patient
counseling is patient education.

Pharmacist C: Patient counseling

is truly “counseling” in the same
way that professional counselors
and therapists use
psychotherapy techniques to
help their clients deal with
problems.
PATIENT COUNSELING

involves counseling in
the psychological
sense, as well as
activities that aim to
educate patients.
Psychological sense:
Behavioral Aspect: Counseling
by persuasion and argument.
- the individual’s false
assumptions, irrational
conclusions, and
misconceptions will be
changed so that he or she
thinks, feels, and behaves on a
more rational basis.
COUNSELING GOALS

1. To establish a relationship
with the patient and to
develop trust.
2. To demonstrate concern and
care for the patient.
3. To help the patient manage
and adapt to his or her
medication.
 COUNSELING GOALS

4. To help the patient manage

and adapt to her or his illness.
5. To prevent or minimize
problems associated with
side effects, adverse effects,
or present and future
noncompliance.
 COUNSELING GOALS

6. To develop the patient’s

capacity to deal with such
problems.
EDUCATIONAL GOALS
Its essence is to enhance patients’
skills and knowledge about their
illness and their medications in
order to bring about necessary
changes in related attitudes and
behaviors.
EDUCATIONAL GOALS
1. To provide information
appropriate to the particular
individual and particular
problem.
2. To provide skills and methods
that the patient can use to
optimize the usage and effects of
the medication.
EDUCATIONAL GOALS
3. To present information and
instruction using
educational methods that
are appropriate to the
particular individual and the
particular situation.
 SUMMARY
Patient Medication Counseling
- is talking with patients about
the medications they are
intended to take so that they will
get the most benefit from the
medications.
5 PHASES OF THE
COUNSELING
PROCESS
 Flow Chart for
PATIENT COUNSELING
1.) OPENING DISCUSSION
Introduction Explain
Purpose of Counseling

2.) Discussion to Gather Information

and Identify Problems

NEW PATIENT RETURNING PATIENT

1. Gather Patient Information 1. Confirm Patient Information
2. Conduct Medication History 2. Confirm Medication-History
Information
3.) Discussion to Prevent or Resolve
Problems and Educate

4.) Closing Discussion

5.) Follow-up Discussion

PURPOSE: DEVELOP A HELPING RELATIONSHIP WITH THE PATIENT
AND A SENSE OF TRUST IN THE PHARMACIST.

POINTS TO REMEMBER:

A.) SET A PERSONAL AND CONVERSATIONAL TONE; CREATE A

FRIENDLY ATMOSPHERE. TRY TO ENGAGE THE PATIENT IN CASUAL
CONVERSATION. (“WARM-UP”)
B.) FIRST MEETING
– PHARMACIST SHOULD INTRODUCE HIMSELF,
STATE HIS NAME AND POSITION CLEARLY.
C.) VERIFY PATIENT’S IDENTITY TO ENSURE THAT THE
CORRECT PATIENT IS RECEIVING THE RX
D.) CONFIRM THAT THE PERSON PICKING UP THE RX IS
INDEED THE PATIENT.
E.) USE THE PATIENT’S NAME DURING COUNSELING SESSION TO
HELP PERSONALIZE THE CONVERSATION.

F.) IF A THIRD PARTY IS PICKING THE RX, THE PHARMACIST MUST

DETERMINED WHETHER THE INFORMATION CAN BE RELIABLY
TRANSMITTED TO THE PATIENT THROUGH THE 3RD PARTY.

G.) IF POSSIBLE, ARRANGE TO SPEAK WITH THE PATIENT IN

PERSON OR BY TELEPHONE TO AT LEAST CONFIRM THAT ALL
INFORMATION AND INSTRUCTIONS HAVE BEEN RELAYED AND
UNDERSTOOD, AND TO EXPLORE ANY PROBLEMS OR CONCERNS
THAT THE PATIENT MAY HAVE.
H.) THE PURPOSE OF COUNSELING SHOULD BE MADE CLEAR TO THE
PATIENT. THE PHARMACIST SHOULD EXPLAIN WHAT WILL FOLLOW, WHY,
AND HOW LONG IT WILL TAKE.

I.) IF THE PATIENT INDICATES THAT HE OR SHE DOES NOT HAVE TIME TO
DISCUSS, ARRANGE FOR ANOTHER MEETING AT AN ALTERNATE TIME
EITHER IN PERSON OR THROUGH TELEPHONE.

J.) PHARMACIST ARE NOT REQUIRED TO OFFER CONSULTATION SERVICES IF

THE PATIENT REFUSES BUT IT IS RECOMMENDED THAT THE PHARMACISTS
MAKE AN EFFORT TO CONVINCE THE PATIENT.

K.) DOCUMENT THAT OFFER TO COUNSEL WAS MADE BUT THE PATIENT
REFUSES.
 Flow Chart for
PATIENT COUNSELING
OPENING DISCUSSION
Introduction Explain
Purpose of Counseling

Discussion to Gather Information

and Identify Problems

NEW PATIENT RETURNING PATIENT

1. Gather Patient Information 1. Confirm Patient Information
2. Conduct Medication History 2. Confirm Medication-History
Information
 Discussion with a New Patient

Basic Patient Information

1. Name, Address, Telephone number,
Age and Gender
2. Patient’s History: Disease states,
Known Allergies and Drug reactions
3. Comprehensive list of medications and
relevant devices

Pharmacist’s comments relevant to the

individual’s drug therapy must also be
noted.
 Discussion with a Returning
Patient
Pharmacist simply has to inquire to confirm
that there are no changes such as new
conditions or medications received
elsewhere, either prescription or
nonprescription.
 Flow Chart for
PATIENT COUNSELING
OPENING DISCUSSION
Introduction Explain
Purpose of Counseling

Discussion to Gather Information

and Identify Problems

NEW REFILL NONPRESCRIPTION

PRESCRIPTION PRESCRIPTION DRUGS
 Discussion for a
NEW PRESCRIPTION
Information to be obtained from
the patient :
1. Previous Use
2. Purpose for Medication
3. Medication Regimen
4. Treatment Goal

In Addition to the PATIENT

INFORMATION & MEDICATION-
HISTORY INFORMATION
Previous Use
a.) Pharmacist must ask if the patient
has taken the medication before.

Purpose for Medication

a.) If the Rx is indeed new, the Pharmacist
must determine the condition being
treated and the patient’s
understanding and perception of his
condition.
b.) Pharmacist should also ask what the
physician has told the purpose of the
medication.
Purpose for Medication

- assess patient’s information needs and

identify potential misunderstanding that
may lead to noncompliance.

- provides an indication of patient’s

language level. The pharmacist should
adopt to the language used by the patient.

- evaluate whether the prescribed medica-

tion is an appropriate choice.
Medication Regimen

- Pharmacist must determine the patient’s

understanding of how the medication is to
be used.

Treatment Goal

- Patient should be asked what he or she

would like to accomplish by taking the
medication.
 Discussion for a
REFILL PRESCRIPTION

Information to be gathered :
1. Details of Medication Use
2. Effectiveness of Medications
3. Presence of Adverse Effects

In Addition to the PATIENT

INFORMATION & MEDICATION-
HISTORY INFORMATION
Details of Medication use

- Pharmacist should determine how the

patient is using the medication and whether
the patient has experienced any difficulty
in taking the medication.

- If a review of the patient record has

indicated noncompliance; Pharmacist should
ask the actual frequency of medication use and
the possible reasons for noncompliance.

- Factors contributing to noncompliance

should be explored.
Effectiveness of Medication

- Pharmacist should ask if the medication is

helping and if it is accomplishing what was
expected.

- Pharmacist should ask about symptoms that

would indicate medication effectiveness in a
clinical sense (e.g., blood pressure levels) but
this should be supported with actual clinical
data from the physician or patient chart.

- This discussion also allows the pharmacist

to identify any misgivings or concerns that the
patient might have.
Presence of Adverse Effects

- Pharmacist should determine any adverse

effects that occurred during the entire drug
therapy.

- Gather information regarding the duration

and severity of side effects in order to allow
the pharmacist and physician to decide if a
change in medication is warranted or if the
side effects are manageable.
 OPENING DISCUSSION
Introduction Explain
Purpose of Counseling

Discussion to Gather Information

and Identify Problems

Discussion to Prevent or Resolve

Problems and Educate

Closing Discussion

Follow-up Discussion
DISCUSSION TO PREVENT
OR RESOLVE PROBLEMS
AND EDUCATE
1.) Developing a Pharmaceutical Care Plan
During the Patient Counseling Process

a.) If real problem have been identified, the

pharmacist should inform and discuss it
with the patient.

b.) The desired pharmacotherapeutic

outcomes should be established.

c.) If the patient’s therapy has to be altered, the

Pharmacist should identify alternatives and be
discussed with the patient. If there must be a
change in the prescribed drug, the physician
must be involved.
Developing a Pharmaceutical Care Plan During
the Patient Counseling Process

d.) After deliberation, the Pharmacist

should determine the best
pharmacotherapeutic solution and
individualize the therapeutic regimen.

e.) Pharmacist should discuss

drug-monitoring plan with the patient.

f.) Any changes in therapy and a plan for

monitoring therapy should be initiated and
documented by the Pharmacist.
2.) Providing Information

The Pharmacist needs to provide

information about the medication he/she is
receiving and about the condition for which
he/she is being treated.

“Standard of practice require pharmacists

to provide at least minimal information to
patients about their medications.”
Providing Information

The type of information that the

Pharmacist may provide may vary with:

- refill prescriptions
- new prescriptions
- nonprescription drugs
Refill Rx and Drug-Monitoring Interview

A.) If noncompliance and adverse effects were

not detected during the information-
gathering phase, the patient may not need
to be given any new information.

- reinforce previous information like

precautions to be observed
- the need to continue with the medications
- about the availability of refills
Refill Rx and Drug-Monitoring Interview

Resolution for Compliance Problems:

1.) Provide information about the patient’s

medical condition
2.) Provide information about the way the
medication is intended to work
3.) Provide reassurance about the efficacy
of the medication
4.) Provide suggestions for altering the regimen
to improve compliance
5.) Provide suggestions for further discussion
with the physician
Refill Rx and Drug-Monitoring Interview

B.) If side effects were detected, information

needed from the Pharmacist are:

1.) actions to reduce side effects like

take with food
2.) reassurance that the effects are mild or that
they are likely to decrease with
continued use of the medication
3.) methods to continue monitoring side effects
and action to take if they become more
severe
4.) recommendation to consult physician for
further assessment
New Prescription

The type of information includes:

1.) The name and description of the drug

2.) The purpose of the medication, and briefly,
how it is intended to work
3.) How and when to take the medication
4.) Compliance suggestions and techniques for
self-monitoring
5.) Side effects and adverse effects
6.) Precautions and Contraindications
7.) Storage instructions
8.) Refill information and Pharmacist Monitoring
Plan
 OPENING DISCUSSION
Introduction Explain
Purpose of Counseling

Discussion to Gather Information

and Identify Problems

Discussion to Prevent or Resolve

Problems and Educate

Closing Discussion

Follow-up Discussion
Closing Discussion

- If the patient appears to be confused

or if a language problem is suspected,
it may be useful to ask the patient to
repeat the most important information,
such as direction for use.

- the Pharmacist needs to reassure

patients that they should feel free to ask
anything at all or discuss any concerns.
Closing Discussion

- It should be used to reiterate and

emphasize the most important points
of the counseling, since the last
message heard is usually the one that
is remembered best.
Follow-up Discussion

- Patient’s progress
- Degree of success of the treatment
and of the plan implemented

“Ensure that outcomes of drug therapy are

Positive.” – responsibility of Pharmacist

To implement follow-up: Explain to the

patient the service will occur if they continue
to patronize the pharmacy.
 Need for Non-Rx Drug
Counseling by Pharmacists

While safe for use without

professional supervision as long as
directions for use are strictly followed…

Potential Problems can arise :

Interactions with other Rx or Non-Rx medicines
Interference with existing chronic conditions
Excessive dosing or chronic use leading to physical
damage and habituation or addiction.
Guidelines for Counseling Non-
Rx

• Referral to an MD for a medical opinion

• Recommendation for non-Rx drug or Non-
Drug treatment followed by selection of
appropriate product & specific
Recommendations for its use.
• Reassurance that no treatment is
necessary.
 Screening vs. Diagnosing
and Prescribing

The Pharmacists generally DO NOT have

the knowledge, skills or training to
make medical diagnoses
Pharmacist may review the symptoms
and consider various factors
Decide when to refer to MD when to
suggest no treatment and when to
suggest self-medication.
The Medication-History Interview
Main Purpose:

To assist the Pharmacist in

identifying real and potential
problems with current and newly
prescribed medications.
 Goals of the Medication-History
Interview
1. To provide a basis for ongoing
assessment of medication use.
2. To evaluate the appropriateness
of the drugs selected and the
dosing prescribed.
3. To evaluate the effectiveness
of past, current, and newly
prescribed medications.
4. To assist the Pharmacist in
identifying other potential and
actual problems associated with
current or newly prescribed
medications such as drug-drug
interactions, drug-disease
interactions, side effects, adverse
effects, allergies, and non-
compliance.
5. To identify factors contributing to
these problems and their possible
solutions.
6. To allow the pharmacist to assess
the patient’s needs for future
counseling and education.
7. To assist the pharmacist in
conducting informed discussions
with the physicians.
8. To help create a helping relationship
between the
pharmacist and patient.

9. To provide an “extra” service

offered by the pharmacy to
gain customer loyalty.
 Conducting the Interview

1. Opening Discussion
2. Inquiry of Personal Information
3. Discussion of Medical conditions
and Medication use
a. Current Medications for the
condition no. 1
b. Past Medications for
condition no. 1
4. Nonprescription Drug Use
5. Discussion of Alcohol and
Tobacco use.
6. Discussion of Drug Sensitivity
7. Closing Discussion
8. Follow-up Discussion
1.) Opening Discussion
a. Introduction and greeting by the
Pharmacist
b. Explain the purpose
a.) Pharmacist should explain that
information about the patient’s
conditions and medication use will be
gathered to get a complete picture of
his or her situation and to help the
Pharmacist ensure that the patient is
getting the most effective therapy
possible.
b. Explain the purpose
b.) The Pharmacist might also explain
that he or she will be checking
for any problems that the patient
may have had in the past with
drug use like Drug Interactions.

c. Ensure Confidentiality
- Confidentiality
- Length of the interview
- Ask consent to continue to set the
stage for cooperation
2.) Personal Information
a.) Name
b.) Address
c.) Health-Insurance Information
d.) Age and Birth date
e.) Occupation
f.) Name of patient’s physician & other
health-care personnel.
3.) Discussion of Medical conditions
and Medication use
1.) Name of the medication
2.) Name of the prescriber
3.) How the medication is used
4.) Duration of use
5.) Efficacy of the medication
6.) Compliance Investigation
7.) Side effects and Adverse Effects
4.) Discussion of Nonprescription
Medication use
1.) Name of the medication
2.) Name of the prescriber
3.) How the medication is used
4.) Duration of use
5.) Efficacy of the medication
6.) Compliance Investigation
7.) Side effects and Adverse Effects
5.) Discussion of Alcohol and
Tobacco use
This topic is more personal and
hence should be introduced with tact,
in a non-judgmental manner.

Pharmacist should explain that

this information is important since
alcohol or tobacco may affect therapy.
6.) Discussion of Drug Sensitivity
- Pharmacist should inquire whether
the patient knows of any medications to
which he or she may be allergic.

- Patient should be asked of any unpleasant

reaction to a medication.

- If there is allergy, Pharmacist should ask

for a description of the effects experienced.
7.) Closing Discussion
- Pharmacist should offer the patient an
opportunity to add any information that
might not have been covered.

- Pharmacist should explain to the patient

that the information will be included with
his or her patient record for future
reference, and that it may be discussed
with the physician if any problems develop
in the course of the therapy.
7.) Closing Discussion
- Confidentiality may be stressed once more.

- If medication is being dispensed at this

time, the Pharmacist will proceed with the
drug counseling.

- If no medication is being dispensed, the

patient may be told that the pharmacist
will review the data to assess the drug
therapy and that the pharmacist will
discuss it further at an arranged time.
7.) Closing Discussion
- Pharmacist may give his or her business
card and offer to answer questions or
discuss concerns any time.

- Patient should be thanked for visiting the

pharmacy.
Assessment and Documentation
1.) Evaluate medication appropriateness
and effectiveness.
2.) Review evidence for medication problems
- Noncompliance
- Drug-drug interactions
- Drug-disease interactions
- Side effects
- Adverse effects
- History of drug sensitivity
Assessment and Documentation
3.) Consult reference texts to evaluate
the problems and to determine the
appropriate course of action.
4.) Additional data like lab tests results
5.) Documentation of the problems,
possible causes, recommended
action, and treatment plan.
6.) Pharmacist should also assess the
patient’s need for future counseling
and education
Assessment and Documentation
7.) If noncompliance has been detected,
- gather information concerning the
noncompliance and add possible
ways to treat the problem.
8.) If the patient has demonstrated a lack
of understanding
- plans to provide information
should be made.
8.) Follow-up Discussion
1.) Contact the physician to inform him or
her of any problems with the
medication detected and to discuss
the treatment of this problems.

2.) Recommending to the physician that the

prescribed therapy be discontinued
or altered and suggesting possible
alternatives.
8.) Follow-up Discussion
3.) Recommending to the patient ways of
using the medication that will
improve compliance and,
consequently, the effectiveness of
the therapy.
4.) Applying various techniques to
overcome noncompliance.
5.) Recommending to the patient methods
for reducing side effects
 Ways of Establishing a
Helping Relationship

• Greeting: friendly and unhurried

• Conversation: Brief general conversation
• Personal Attention: Introduce self and use
patient’s name
 Ways of Establishing a
Helping Relationship

• Encourage questions & response

• Demonstrate genuine Interest and concern:
Spend time, explain, display empathy
• Nonverbal language: showing attentiveness,
interest and concern
 Basic Steps in Counseling
• Introduction
– Pharmacist
– Patient
• Basic Interview Questions:
– What did the doctor tell you about your
medications?
– Were you given information on how to use
these medicines?
– Have you taken these medicines before?
• Information-giving
– Follow recommended content of PMC
• Summary of Important Points
• Closing
 A responsible pharmacist sees to it
that
a trusting relationship with a patient
is developed
an open exchange of information
ensues
a patient is involved in the decision-
making process and that
therapeutic goals are achieved through
EFFECTIVE COMMUNICATION
Compliance – is defined as the extent
to which a person’s behavior coincides
with medical or health advice.

Non-Compliance – is the failure to

follow what is required in the
prescription.
The Issue of Non-compliance

 Non-compliance or non-adherence, is a
patient’s failure to follow a drug regimen as
instructed
 40-60% of patients in the USA not taking their
medications as prescribed
 Takes the form of inadequate/excessive intake,
incorrect frequency, discontinuation and intake
of medication other than prescribed
Causes of Medication
Self-Regulation (Non-compliance)

1.) Health Beliefs (Patient)

a. perceived lack of seriousness of the
disease and outcomes of nontreatment
b. perceived ineffectiveness of the
treatment
c. lack of social support
d. complex medication regimens
e. lengthy therapies
f. presence of adverse effects
Causes of Medication
Self-Regulation (Non-compliance)

1.) Communication (Physician-Patient)

a. low degree of medical supervision
b. perceived ineffectiveness of the
treatment
c. lack of social support
d. complex medication regimens
e. lengthy therapies
f. presence of adverse effects
 Communication Skills in
Patient Medication Counseling

Attending & Active Listening

Skills
Emphatic Responding Skills
Interviewing Skills
Influencing Skills
 Attending and
Active Listening Skills
• Facial expression
• Posture
• Tone and loudness of voice
• Use of verbal encouragers
• Eye contact
• Body gestures
Active Listening

LISTENING FILTERS

Organizational Previous
Role Attitudes Values Bias, etc.
experiences

RE
MB
UNDERSTANDING INTERPRETING
ERI
NG RESP
HEARIN ONDIN
G G
EVALUATING
 Tips on Active Listening
• Stop talking. You can’t listen when
you talk.
• Get rid of distractions. These break
your concentration
• React to the ideas, not to the
person.
• Read nonverbal messages.
• Listen to how something is said.
• Provide feedback to clarify any
messages.
Empathic Responding Skills

• Reflecting - concentrating
on the emotional meaning
• Paraphrasing - conveying
the essence of what was
said
• Focusing - getting back to
the topic of conversation
 Interviewing Skills
• Ask open questions
• Ask closed questions
• Check if the patient
has understood or
requires more
information
 Tips on Effective Interviewing
• Avoid suggesting during data-
gathering phase.
• Do not jump into conclusion w/o
hearing all facts.
• Avoid shifting from one topic to
another until one is finished.
• Provide a balance of open & closed
questions.
• Keep goals of the conversation clear
in your mind.
• Maintain OBJECTIVITY !!!
 Influencing Skills
• Give relevant advice
• Share correct information
• Make good suggestions
• Summarize main points of
information given
 Tips on Giving Advice
• Emphasize key points with
“This is important…”
• Give reasons for key advice
• Give definite, concrete, explicit
instructions
• Supplement spoken word w/
written instruction
• Check for accuracy of patient’s
understanding of the
instructions given
 REGIMEN HEALTH
Frequency, PROFESSIONAL
duration & Knowledge,
complexity skills, attitudes,
practice issues
PATIENT
Health beliefs,
knowledge,
understanding,
attitude, skills
functional state
DRUG
type, form, ENVIRONMENT
number,side &
Non- Significant others,
adverse effects
compliance physical isolation,
devices
DRUG COMPLIANCE