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Health Promotion Practice

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Practicing Health Promotion Through Pharmacy Counseling Activities


Ashish Chandra, Nathaniel Malcolm, II and Margery Fetters
Health Promot Pract 2003; 4; 64
DOI: 10.1177/1524839902238293
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HEALTH PROMOTION PRACTICE / January 2003


ARTICLE

Practicing Health Promotion Through


Pharmacy Counseling Activities
Ashish Chandra, MMS, MBA, PhD
Nathaniel Malcolm II, BS, PharmD
Margery Fetters, MBA, MS

Dramatic changes in the U.S. health care system have


emphasized the need to promote good health. To
achieve this, different types of health care professionals
have now started working together. These teams often
include participants, such as doctors, pharmacists, and
nurses. However, there are many health professionals,
such as pharmacists, working in noninstitutionalized
settings, such as pharmacies, who are not being fully
utilized. One of the ways pharmacists can promote good
health is by counseling patients. This article provides
some insights regarding the various health promotion
activities that are or can be performed by pharmacists.
Health promotion educators can play a significant role
in educating pharmacists to become effective health
promoters. Some hypothetical scenarios and examples,
as well as models, are also provided to demonstrate
active health promotion through pharmacist counseling
activities.

ver the past few decades, the U.S. health care


system has seen some significant changes. These
dramatic changes have made the system, which
includes both public and private health care institutions, more confusing, turbulent, and alarming for
health care consumers (Ginter, Swayne, & Duncan,
1998). It has also been observed that many health care
professionals are spending less time on patient evaluation. At the same time, through various media, consumers have become more aware of health care and are taking a greater interest in their health care status. When
these situations are combined, there is great potential to
create a volatile predicament for health care providers
and consumers.
Another major factor that has significantly affected
the health care system relates to escalating health care
costs. This is, perhaps, the main reason why more and
more consumers are seeking added insurance benefits
Health Promotion Practice / January 2003
Vol. 4, No. 1, 64-71
DOI: 10.1177/1524839902238293
2003 Sage Publications

from their employers. Many health insurance providers


do not cover doctors visits to patients homes. This has
drastically reduced the number of doctors making
house calls. Most patients visit a doctor either at his or
her private practice office or in a hospital. Expenditurewise, hospitals are, in fact, the largest segment of the
health care industry, absorbing about 36% of all health
care expenditure dollars. Drug and other medical nondurable products absorb only 9.4% of the overall health
care expenditures (Cleverley, 1997). It has been commonly observed that if drug costs go up by only a few
cents, the health care consumer becomes concerned. On
the other hand, many consumers tend not to express
concern if there is an increase of a few dollars at the
health care institution. One of the main reasons for not
questioning the increased expense could be that consumers may perceive that they are getting more service
for their money. Hence, it is extremely important for
pharmacies and pharmacists to provide a service that is
considered of some value by the consumer. Pharmacists
should alert consumers that they are also part of the
health care team.
There are many types of health care professionals involved in the treatment of a patient, such as doctors,
nurses, and pharmacists. Besides these professionals,
there are others who are also considered valuable members of the health care team offering important health
care services to the patient. Doctors often provide patient care activities in both institutionalized and
noninstitutionalized settings. The average physician
writes about 8,000 prescriptions per year for prescription as well as nonprescription medications, and currently over 2 billion prescriptions are dispensed annually (Holt, McCrory, Norris, & Sandler, 1996). Nurses,
on the other hand, provide most of the services in an institutionalized setting. Most pharmacists provide their
services in an independent setting, often not located in
the health care institution. Some of the pharmacists duties include monitoring patients profiles, recognizing
possible adverse drug affects, compounding drugs as directed in the doctors prescription orders, and counseling patients regarding their prescriptions and over-thecounter medications interactions. Consumers purchase
hundreds of millions of dollars worth of nonprescrip-

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tion (over-the-counter) medications (Mayo Clinic,


1993). In recent years, pharmacists have also begun going on rounds with physicians and providing patient
counseling regarding drug therapies in an institutionalized setting.
Counseling has become a very important component
of the pharmaceutical profession. Most colleges of pharmacy have incorporated required courses to educate
pharmacy students in counseling and communication
skills (Molzon, 1992). Counseling is actually considered
a free, value-added service offered in pharmacies by
highly trained health care professionals. Counseling
can help promote good health by intervening in, and often monitoring, patients drug therapy. This can be beneficial by early detection of possible adverse drug interactions, which can often be fatal or expensive if not
detected early. Counseling can also help educate consumers regarding their condition and can facilitate patient compliance. In fact, the law in most states now requires counseling.

IS THE LAW:
> COUNSELING
ROLE OF OMNIBUS BUDGET
RECONCILIATION ACT OF
1990 (OBRA 1990) IN PATIENT
COUNSELING
OBRA 1990 is one of the most important laws affecting patient counseling activities in a pharmacy setting.
OBRA 1990 instituted an important pharmacy-related
provision that went into effect on January 1, 1993. The
key provisions of this legislation were to increase the
pharmacists responsibilities to educate and counsel patients about prescribed drugs, to assure the appropriateness of the prescribed therapies or prospective drug utilization review, and to provide for the collection of
patient information (OBRA, 1990; Perri, Kotzan, Pritchard, Ozburn, & Francisco, 1995). According to this
provision, pharmacists must offer counseling to all
Medicaid patients (Brenner, 1992; OBRA, 1990). Since
then, most state boards of pharmacy (44 out of 50) have
passed legislation mandating that pharmacists should
provide patient counseling to all patients, not just
Medicaid patients (Perri et al., 1995).
OBRA 1990 established increased responsibilities for
the pharmacist, from being only a dispenser of medications to a health professional who helps ensure proper
use of prescribed medications. The passage of OBRA
1990 had specific implications for the practice of pharmacy. First, pharmacists were required to offer counseling to Medicaid patients when a new prescribed medication or a refill for an existing prescription was
dispensed. Second, it required state Medicaid programs
to establish drug use review programs that rely heavily
on pharmacists expertise. Last, OBRA 1990 authorized
demonstration programs to determine the effect of reimbursement of pharmacists for patient counseling
(Christensen et al., 1999). OBRA 1990 has saved the
Medicaid program millions of dollars annually by en-

The Authors
Ashish Chandra, MMS, MBA, PhD, is an associate professor in the Graduate School of Management, Marshall University Graduate College, South Charleston, West Virginia.
Margery Fetters, MBA, MS, is associate professor of marketing and management, North Central College, Naperville,
Illinois, and currently owner of CS Consultants.
Nathaniel Malcolm II, BS, PharmD, is a GlaxoSmithKline
Pharmacoeconomic and Health Outcomes Post Doctoral
Fellow and a candidate for the masters in pharmaceutical
administration at The Ohio State University.

couraging manufacturers to give state Medicaid programs the opportunity to purchase drugs at the lowest
prices available to any health care entity within the
United States (Christensen et al., 1999).
A study conducted at the University of Mississippi
indicated that pharmacists derive professional satisfaction from counseling patients (Meade, 1995). Though
data regarding the success or failure of OBRA 1990 are
scarce, there is anecdotal evidence that this law is having a positive effect on patients and the pharmaceutical
profession (Meade, 1995; Torg, 1992). A study conducted in Georgia indicated that even though the number of patients counseled by pharmacists has increased
in the post-OBRA period, the amount of time spent collecting patient information and patient counseling has
decreased (Perri et al., 1995). The same study also indicated that only 12.4% of consumers surveyed were
aware of the OBRA 1990 legislation. Of those consumers who received prescriptions since the OBRA 1990
legislation took effect in January 1993, only 33% indicated that the pharmacist personally counseled them
about their prescriptions.
In an effort to comply with OBRA 1990 regulations,
many pharmacists often face several barriers. Some of
the factors affecting counseling activities, as determined by pharmacists, include excessive workload,
lack of financial compensation, and patients attitudes.
According to a study by Barnes, Riedlinger, McClosky,
and Montagne (1996), almost half of the responding
pharmacists indicated that OBRA 1990 regulations had
not affected or changed their practice, one quarter of the
pharmacists believed their practice was less rewarding
after implementation of OBRA 1990, and about one fifth
believed it was more rewarding. This demonstrates that
patient interaction cannot be legislated but can be developed through motivation and appropriate reimbursement.
In a study by Scott and Miller (1999), it was determined that pharmacists spend 13% of their day on patient counseling. These respondents reported that there
was an increase in the time spent by them on counseling, which was a direct result of OBRA 1990. The average increase was 2.8 minutes at an estimated cost of
$4.63 per prescription filled. As mentioned earlier,
OBRA 1990 requires the pharmacist to offer counseling
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65

with each prescription filled for a Medicaid patient.


However, a significant majority of the pharmacies and
the pharmacists had not been compensated for these additional costs. Only 8% of the pharmacists have charged
for patient counseling, and only 2.8% of those pharmacists were reimbursed. In essence, only 33% of those
pharmacists who have charged for patient counseling
have been paid or reimbursed (Scott & Miller, 1999).
Pharmacists seem to have minimal economic incentive to provide patient counseling because it is unlikely
that they will be reimbursed. Lack of pharmaceutical
care can negatively affect both the physical and emotional well-being of the patient and adversely affect insurers who often bear the drug-induced morbidity and
mortality costs. Clearly, it would be beneficial to the patient, the patients pharmacist, and the patients insurer
to advance financial compensation policies that will
foster increased patient access to pharmaceutical care
and promote good health.

PROMOTION BY
> HEALTH
WAY OF COUNSELING
A well-accepted definition of health promotion is the
science and art of helping people change their lifestyle
to move toward a state of optimal health (ODonnell,
1986, p. 4). Over the years, it has been observed that
health care professionals have changed the way they
provide health care services to their patients. The patient care model of practice has changed from being a
practitioner-centered model, in which the patient was
acted upon, to being a patient-centered model in which
the patient is considered an active participant in the
treatment regimen (Tindall, Beardsley, & Kimberlin,
1994). In the practitioner-centered model, the patients
opinion was not considered paramount. It was thought
that the health care providers opinion superceded any
opinion expressed by the patient. However, with the increasing adoption of the patient-centered model, health
care professionals have started paying more attention to
the opinions expressed by patients. Patients are also being encouraged to take a more active role in their health
care, and, as a result, counseling is now considered an
invaluable aspect of any patient care services. This includes pharmaceutical care provided by health care
professionals such as doctors and pharmacists.
Currently, pharmacists are in an excellent position to
actively promote good health through patient counseling activities. Pharmacists are considered one of the
most respected health care professional groups. In a
Gallup poll ranking 25 different professions for honesty
and ethics among its practitioners, two thirds of the respondents rated pharmacists as the most respected of all
professionals (Haddad, 1990). A study titled Patients
Perceptions of Increased Pharmacy Contact found that
patients desired and appreciated greater contact with
pharmacists because they sensed that pharmacists were
approachable and were highly regarded for their ability
to communicate useful health-related information
66

(Erstand, Draugalis, Waldrop, Scheurer, & Namanny,


1994). Perhaps one of the most enticing factors for patients was that pharmacists do not charge for their counseling services.
Counseling is important for pharmacists and patients. Very often, patients do not fully understand another health professionals advice. They may think of
additional questions they intended to ask the health
care provider but were unable to ask due to lack of time
during their office visit. The inability to get an answer to
their question may be quite disturbing to patients. If
they get the answer to their question, they will have
greater peace of mind. The next source for answering
the patients questions is perhaps the local pharmacist,
and often patients ask the pharmacist the most daunting
questions. Many pharmacists take time to provide adequate answers to the patients questions in a manner
that is nontechnical and can be understood by a
layperson. As a result, patients may be very receptive to
information provided by the pharmacist, irrespective of
whether it is new information or reinforcement of information given earlier. Pharmacists have many opportunities to counsel and intervene at the individual level.
Counseling can include intervening in a patients drug
therapy, providing education to patients about their
condition, and, ultimately, helping improve patient
compliance.
Pharmacist Intervention in Drug Therapy
Intervention is necessary to prevent any potential
health problems caused by adverse drug reactions.
There are some common steps that a pharmacist takes to
prevent potential drug-related problems. In the case of a
new prescription for a patient, the pharmacist reviews
the patients profile for patient history and obtains additional history from the patient, if necessary, such as
over-the-counter drug product use. The pharmacist may
assess the patients profile on the computer for current
drug use, interacting medications, duplicate therapies,
contraindications to the patients condition, and patients age. If there are potential problems, the pharmacist contacts the patient or physician who prescribed
the medication for further information to intervene with
appropriate recommendations (Rupp, 1992).
Pharmacists usually intervene in patient drug therapy with the elderly. Elderly patients are most likely to
be taking multiple medications and may have a potential adverse drug reaction. According to a study, age itself has not correlated with adverse drug reactions, but
the presence of multiple conditions or multiple medications do correlate with the incidence of adverse drug reactions (Grymonpre, Mitenko, & Sitar, 1988). The number of medications taken is also correlated with the
number of potential drug interactions and drug problems in the elderly (Johnson, 1991).
Pharmacists can easily detect drug problems by identifying multiple medications the patient is taking by reviewing the patients profile on the pharmacys com-

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puter system and providing intervention as appropriate.


Providing appropriate intervention can improve a persons health. A study by Chin, Muller, and Lucarelli
(1995) evaluated pharmacists contribution to patient
care through an intervention program. The most common interventions that had an impact on patient care
were recorded, 2,499 in all. The most common types of
interventions were clarification and change of prescription order (18%), consultation on how medications
work in the body (16%), and review of patients charts
and profiles (13%). These interventions had impact on
patients. Forty-one percent of the people had decreased
drug toxicity levels, 17% had decreased money spent
on medication, 16% avoided drug interaction, and 8%
improved compliance with the medication.
If it is determined that the prescription drug should
be dispensed, the pharmacist will counsel the patient
about the appropriate use of the drug product and
potential drug interactions. The pharmacist usually discusses signs and symptoms of potential problems, how
to avoid problems, and the importance of compliance.
After counseling the patient, the pharmacist may also
provide an information leaflet about the newly dispensed medication for the patient to take home
(Kimberlin, Bernardo, Pendergast, & McKenzie, 1993).
Educating Patients About Their Diseases
Educating patients may help people to be more motivated to maintain good health. The pharmacist can provide added motivation to the patient by demonstrating
an interest in the patients progress through his or her
therapy and disease state. A motivated patient is more
likely to engage in positive lifestyle changes. By educating patients about their diseases, the pharmacist can
help them assume more responsibility for restoring and
maintaining their health.
The scenarios below are examples of how health promotion is included in pharmacy practice:
Scenario 1
A mother presents a prescription for an antibiotic
for her childs upper respiratory tract infection. The
pharmacist notes from the childs patient profile that
the child has had recurrent respiratory tract infections in the past 3 months. While being counseled on
the proper use of the medication, the mother
expresses concern about her childs frequent infections. The pharmacist asks her if anyone in the
household smokes, and she replies that she does. At
this time she may be willing to consider the fact that
her smoking may aggravate her childs infections,
and she and her child could benefit if she stopped
smoking. The pharmacist, at this opportunity, may
point out these benefits and refer her to a program to
stop smoking or to see a physician. The pharmacist
can also point out the various over-the-counter smoking cessation aids that are readily available to consumers. However, in doing so, the pharmacist should
not breach the concept of fidelity, that is, push for the

best product available and not the one that will make
the most profit (Tindall, Beardsley, Kimberlin 1994).
Scenario 2
A man with high blood pressure comes into the
pharmacy to have his prescription for an antihypertensive drug refilled. Before filling the prescription
the pharmacist may ask him if he has had his blood
pressure checked. He replies that he has not checked
his blood pressure in a while and wonders about his
blood pressure level. The pharmacist may ask the
patient if he has consumed meals high in sodium,
and he replies yes. The pharmacist tells the man that
food high in sodium may elevate blood pressure, that
it would benefit him to reduce his intake, and that he
should go back to see his physician. At this point, the
patient may realize the importance of the pharmacists advice and take appropriate action to prevent
any further complications associated with high
blood pressure.

Counseling Improves Compliance


Often when the pharmacist asks a patient What
problems are you having with your medicine? the response is None. Although in many cases this is the
truth and the patient is not experiencing any adverse effects, the pharmacist may raise more specific questions.
The pharmacist may use a head-to-toe approach, which
involves inquiring about adverse effects one at a time,
from head to toe (Lewis, Lasack, Lambert, & Connor,
1997). For example, a patient prescribed Coumadin (generic name warfarin) could be asked about nosebleeds,
bleeding gums, or unusual bruising. Going from head to
toe helps the pharmacist keep track of the questions and
provides some continuity for the patient as well.
At the time of assessing for compliance the pharmacist can make the patient feel comfortable, especially if
the pharmacist senses that the patient has not been fully
compliant. If the patient feels comfortable, he or she
will more willingly be truthful. Also, pharmacists may
inform patients that change in their drug therapy might
be based on the physicians understanding of what medication they are taking. For example, a patient with uncontrolled blood pressure due to noncompliance may
be started on new medications. Often, the patient is unhappy because he or she does not want to take another
medication. It is important for the patient to understand
that if compliance is achieved, medications might then
be eliminated.

TECHNIQUES AND
> ALTERNATIVE
CHANNELS OF COMMUNICATION
FOR COUNSELING ACTIVITIES
In the concept of pharmaceutical care, one of the
most important services that a pharmacist offers is
counseling a patient on the appropriate use of pharmaceutical products (Hepler & Strand, 1989). Patients
should have a good understanding of the nature of their
drug therapies. For example, the patient should know
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67

about the drug doses, how long the drug


should be administered, and the possible side
effects of the drug. Most pharmacies are not
designed for effective pharmacist-patient interaction. In most instances, the pharmacist is
physically removed from the patient by several feeta counter, glass partition, or other
physical barrier (Tindall et al., 1994). However, some pharmacies have designated private areas for confidential discussions, free
Evolving Channel of Communication
from distractions or interruptions.
Aside from having an environment that may
or may not be conducive to pharmacist-patient
interaction, many pharmacists try to effectively communicate with the patients. Pharmacists will try to make the patient feel comfortable by allocating space for a more desirable
one-on-one private conversation. Many people
like to talk about their medical problems without other people standing next to them. Any
element of privacy and confidentiality allows
for better pharmacist-patient interaction.
The most common communication techniques used in patient-pharmacist communication are the telephone and face-to-face,
interpersonal communication. However, it has FIGURE 1 Information Flow and Modes of Communication Between
been observed that in some pharmacies, Patient and Pharmacist
patients are now communicating via e-mail
(see Figure 1). This technologically advanced
Online communication between the patient and the
communication technique requires certain equipment,
pharmacist is currently in its developmental stage (see
such as computers, and technological skills for both
Figure 1). The benefits of online communication are
participants. This form of communication may not
that pharmacies can provide a customer with written
always be possible and feasible, however, considering
product information, references to other sources of inthe cost of the technology for the consumer.
formation, and updated information. It will take some
Most of the time the patient-pharmacist interaction is
time to determine whether or not both the consumer
for the purpose of dispensing medication to the conand the pharmacist accept this technology-based comsumer. This may be for a new prescription or for a refill.
munication technique. However, this form of communiFor a new prescription, the patient-pharmacist interaccation is quite prevalent between the pharmacy and the
tion is often face to face. However, it has been observed
insurance company.
that more and more consumers are requesting refills via
the telephone and come at a later time to pick them up.
Technique of Adapting to
Because a large percentage of requests for refills are bePatients Behavioral Changes
ing made via the telephone, many pharmacies have installed an automated telephone system to reduce the
Anyone who has ever tried to change a persons bemanpower needed to answer each telephone request.
havior knows how difficult it can be. A way for pharmaConsumer requests via the telephone appear on a comcists to understand patients behavioral changes is to faputer monitor and are sorted according to the time they
miliarize themselves with recent developments in the
were received. This sort of refill request has proved to
study of scientific change. One study that integrates perbe quite beneficial for the pharmacists. They have more
spectives to describe and explain behavioral change is
time to perform other activities, such as counseling, bethe model developed by Procheska, DiClemente, and
cause the pharmacy technician usually takes the request
Norcross (1992). The key insight of the model is behavand fills the prescription. The pharmacist merely
ior changes at each stage, and pharmacists need to gauge
checks the prescription for proper dispensing and apwhat stage of change patients are at before deciding to
propriate authorization by the insurance company.
intervene (Procheska et al., 1992). For instance, a newly
Other studies have indicated that telephone calls in
diagnosed diabetic patient has different needs than a
pharmacies do interfere with the professional duties of
person who has lived with the disease for 10 years. A
the pharmacist because a large percentage of the calls do
person who needs to alter unhealthy behaviors has difnot even require the expertise of a pharmacist (Chandra,
ferent needs than a person who is trying to maintain a
Blake, & Holt, 1996).
newly adopted healthy behavior.

PATIENT

PHARMACIST

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Because patients will be at varying stages of behavioral changes to improve their health and maximize
therapeutic outcomes, the pharmacists counseling
techniques need to adapt to change. Pharmacists may
need to be more sensitive to the damage that illness can
do to a patients self-image. Lambert, Street, and Cegala
(1997) suggested that staying healthy is a matter of
maintaining a balance between self-image and performance. Self-image is a persons understanding of his or
her own identity and performance of activities of daily
living (Lambert et al., 1997).
Pharmacists communicate effectively when they
keep in mind each patients need to balance self-image
and performance. New medications and new adverse
drug reactions may upset this balance, with serious consequences for the patients quality of life (Lambert et al.,
1997). For instance, a man who has hair loss may perceive himself as a healthy, sexually active male with a
full head of hair. When this patient becomes impotent
as a result of a medication to treat hair loss, the balance
between self-image and performance is upset, and he
begins to feel unhealthy. He may then change his selfimage and see himself as a bald, sexually active male instead of a sexually active male with a full head of hair.
Also, he may alter his performance by stopping the
medication or asking the doctor to prescribe a different
medication to treat his hair loss.
The option chosen by the patient may be at least partially dependent on his relationship with his pharmacist. That example points out the concept of balance, because it shows that patient counseling often requires the
pharmacist to raise issues that may not be comfortable
for the patient or the pharmacist to discuss. These discussions are sometimes necessary to enable the pharmacist to ensure appropriate drug therapy outcome.
Pharmacist-Patient
Communication Models
Many patient counseling models are currently in
place, and some of them are extremely valuable. Two of
these models are the pharmacy consultation program by
Pfizer (1995) and the health communication model by
Svarstad (1986). The pharmacy consultation program
was developed for pharmacists, whereas the health
communication model was developed primarily for
physicians but is often used by pharmacists. Irrespective of whom these models were created for, both had a
common purpose to improve patient health through
various promotional activities.
The pharmacy-consulting program by Pfizer (1995) is
based on open-ended questions that help determine the
patients knowledge of his or her disease and medications. This ensures that by the end of the counseling session the patient understands how to use medications
and what to expect from the medications. Open-ended
questions usually start with words like how, why, what,
or when. An example of an open-ended question is
What did the doctor tell you that your medication is

used for? (Pfizer, 1995). Open-ended questions are


usually better than closed-end questions because they
give an opportunity to the patient to express their feelings, concerns, and expectations more clearly in their
own terms.
After using open-ended questions, many specific
points should be discussed for every new medication,
as suggested by OBRA 1990. The name, dosage, route of
administration, and duration of use should be addressed when counseling a patient. Furthermore, the
pharmacist should address common side effects, drug
interactions, techniques for self-monitoring therapy,
and prescription refill information (Martin, 1993). This
will help the health care professional in identifying possible drug-related mishaps, such as drug interactions,
noncompliance, and other concerns that may hinder the
patients health and the patients perception of their
health.
Another patient counseling model is the health communication model (Svarstad, 1986). This model reflects
the primary importance of the patient-health provider
relationship in ensuring compliance and provides strategies for enhancing patient understanding. The strategies for enhancing patient comprehension are providing
clear directions for what the patient is supposed to do
and explaining the purpose of the therapy. This information should be repeated and patients should be provided simplified instructions in lay terms. Also, the
health provider should offer written information together with the oral counseling. If there are multiple visits by the same patient, the health provider should offer
consistent advice and recommendations.

OF HEALTH EDUCATOR
> ROLE
IN PREPARING PHARMACIST
Now that patients are becoming active participants in
their health care, it is extremely vital for pharmacists to
be promoters of good health to consumers. The pharmacist must have a good understanding of the various social and behavioral aspects as well as the physiological
aspects of the consumer. Though pharmacists are provided some understanding of these aspects in most
pharmacy programs, there is now an increasing need to
pay greater attention to these issues during their professional education. Health promotion educators often
spend a great deal of time in understanding and analyzing the social and behavioral aspects of consumers
health. Pharmacists, on the other hand, spend more
time in understanding the physiological and other scientific aspects as they relate to consumers health.
Hence, by training and education, health promotion educators may perhaps be the most effective individuals
to educate pharmacists about the various sociobehavioral aspects of the consumer, making pharmacists effective and good health promoters.
In the opinion of the authors, it would be better to
have a nonpharmacist individual involved in health
promotion training for pharmacists. We believe that
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69

these individuals may be able to provide the information in a nonscientific, unbiased manner. Even though
the health promotion educators may not be scientifically trained health care professionals, they have the
ability to provide knowledge and good health promotion strategies utilizing an outsiders perspective. They
can also be contributing members of the health care
team.
Health promotion educators can also assist pharmacists in developing innovative educational tools for
high-risk individual consumers. They can help the
pharmacists in the development of appropriate evaluation tools that can help assess the impact and effectiveness of the patients education efforts. It is highly recommended that these evaluations should be performed
using standardized forms. These forms should be carefully modified, as and when necessary.

> CONCLUSIONS

Patient counseling should be viewed as only one


component of the overall drug-use process. However,
this activity should not be ignored or inadequately performed because it may hinder good health promotion
practice. As consumers become more aware of the various laws that affect their health, such as OBRA 1990, it
can be safely assumed that the demand for pharmacist
counseling is likely to increase. To counsel patients effectively about use of medication, pharmacists need to
appreciate the personal impact of illnesses and understand communication models. Pharmacists should become well accustomed to the various channels of communication, particularly the Internet and e-mail
channel because it may be prevalent in the future.
Health promotion educators can play a significant
role in educating pharmacists regarding appropriate, effective communication styles. Hence, it is increasingly
important to consider health promotion educators as vital members of the overall health care team. This article
can serve as one of the starting points for a future study
to assess the impact of the association between pharmacists and health promotion educators on consumers
health.

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