PATIENT

COUNSELING
NAME :- G VARSHITH

Pharm d IV YR

16Z51T0006
 PATIENT COUSELING:
Patient couseling is defined as “providing
information to the patient or patients care giver regarding
the disease, medication,diet and life style modifications in
layman language to achieve the desirable therapeutic
outcomes”.The information may be given verbally and
complimented with written information leaflets.

The communication process between health

professionals and patients serves two primary
functions.
1.It establishes an ongoing relationship between the professional
and the patient.
2.It provides the exchange of information necessary to assess a
patient’s health condition, implement treatment of medical
problems, and evaluate the effects of treatment on a
patient’s quality of life.

The healthcare professional must be able to

-understand the illness experience of the patient.

- perceive each patient’sexperience as unique.

-foster a more egalitarian relationship with patients.

-build a therapeutic alliance with patients to meet mutually

understood goals of therapy.
The healthcare professional should encourage patients
to share experiences with therapy because
-they have unanswered questions
-they have misunderstandings
-they experience problems to therapy
-they can “monitor” their own responses to treatment
-they make their own decisions regarding therapy
-they may not reveal information to
you unless you initiate a dialogue

Communication during drug therapy

-Purpose of medication
-How medication works
-Dose and duration of therapy
-Goals of therapy
-How effectiveness will be monitored
-Adverse effects and how to deal with them
-Drug specific issues

Communication skills required for effective

counseling:
Patient counseling is an art as well as science. Knowledge
regarding medicines and diseases and skills to communicate
effectively make the pharmacist as a good counselor.
Counseling skills can be improved over a period of time by
practice.
Counseling process are 2 types
1)Verbal communication skills:
Skills include language and paralinguistic features such as
tone,volume,pitch and rate of speech. Paralinguistic , or the way
we say words,account for 40% of how messages received so the
way in which we speak has an impact in patient understanding.
a)Language:
While speaking with patients , use simple language and
avoid unnecessary and difficult medical words. If
possible,communicate the information in patients own language.
b)Volume:
Ideally counseling should be conducted in a quite
private setting where it is necessary to raise ones voice.
c)Tone:
Tone of our voice is very important during the course of
counseling. Changes in the leveol and range of pitch convey
information about the feelings and attitude of a person
speaking.During the counseling the tone of the voice should be
caring and reassuring.
d)Speed:
the clarity of our communication depends on our rate
of speech for good verbal communication,the pharmacist should
present clear,relevant messages in logical sequences, and at a
speed which gives the patient time to think about what is being
said.This will help the patient to understand and remember the
concept more easily.
NON-VERBAL COMMUNICATION SKILLS:
It includes body language such as movement and position of the head,
limbs and body and other aspects such as whether pharmacist is dressed
in a professional manner. The aspects of non-verbal communication
skills include proximity, touch, eye contact, facial expressions, head
movements, gestures with hands and body posture.

 PROXIMITY: It refers to distance that people maintain between

themselves during counselling process which is classified into 4
zones:
1. Intimate: 45cms or less
2. Personal: 45cms-1.2mts.
3. Social: 1.2mts-3.6mts
4. Public: >3.6mts
  EYE CONTACT: The amount that people look at one another
during conversation varies depending on whether they are speaking
or listening.
 FACIAL EXPRESSION: These can be used to demonstrate
empathy towards the patient.

PATIENTS REQUIRING COUNSELLING:

 Patients or their care givers confused about the use of medicines.
 Patient with impaired sight or hearing.
 Illiterate patients whose profile shows a change in medications or
dosing.
 New patients or those receiving a medication for the first time.
 Patients receiving medications on behalf of children.
 Patients receiving medication in mechanized devices such as
inhalers, Rotahalers and medications with special storage
requirements, complicated directions and with significant side
effects.
BARRIERS OF PATIENT COUNSELLING
Following are the barries identified for not happening of the
patient counseling in india
1)Patient based barrier
2) system based barrier
3) provider based barrier
 1) Patient based barrier:- counseling happens only when
patient show interset in receiving the information if there are
in hurry to reach hoe it is very difficult to talk to them
gender difference , language difference and literacy
Or the identified patientg based barrier
2) System based barrier :- lack of reimbursement due to non
legalization of patient counseling, lack adequate space and
trained staff and the busy hours are considered as a system
based barrier
3) Provider based barrier:- provider is a pharamcist in india
majority commmunity pharmacies run by pharmacist having
diploma in phramacy qualification in their knowledge and
their commitment towards counselling are inadequate . lack
of interset , lack of time , lack of knowledge , lack confidence
STRATEGIES TO OVERCOME THE COUNSELLING
BARRIER:-

-Using multimedia materials

- pictograms
- oral or written information
- compliance aids
- follow up schedules
OBJECTIVES OF PATIENT COUNSELING:-
 Patient should recongize the importance of mecication
for his well being
 A working realtion ship and a foundation for continous
interaction and consulation should be established
 Patient undersatnd of strategies to deal with medication
should be improved
 Should ensure better patient compliance
 Patient becomes an informed, efficient and active
participant in disease treatament and self care
management
 The pharmacist should be perceived as a profressional
who offers pharmaceutical care

FUNCTIONS OF PATIENT COUNSELLING

Effective pateint counseling aims to produce the
following resulting
1) Improved medication adherence
2)More effective drug treatment
3) Reduced incidence of adverse effect and unneccesary
health care cost
QUALITIES OF A GOOD COUNSELER
- Be a good listener
- Be flexible
- Be empathetic
 - Be no judgemental
- Be tolerant
- Communicate confidently
STEPS FOR PATIENT COUNSELLING:

 PREPARING FOR THE SESSION:

Success of counselling depends on knowledge and skill of counsellor.
The pharmacist should know as much as possible about the patient and
his/her treatment details. In hospital setting it can be achieved by
referring to patient’s case notes. In community pharmacy setting sources
of information include patient and their prescription, and in few cases a
record of previous dispensing for the patient. A drug information
reference can be consulted before commencing counselling if any drug
is not known to pharmacist.

 OPENING THE SESSION:

The first phase of counselling is used for information gathering. The
pharmacist should introduce him or herself to the patient and greet by
name. It is best to use titles such as Mrs. and Mr. switch over to first
name. The pharmacist should identify the purpose of session very
clearly.
The pharmacist gathers information from the patient about their
understanding of the disease they are suffering from, drug treatment, use
of alternative medicines, drug allergies. Past medical history, social
history such as smoking, consuming alcohol etc.,
Using open ended questions is useful technique for gaining the
confidence of patient and answers allow the pharmacist to assess the
patient’s information needs. Reflective question is also useful approach
for gathering information on certain points. a few kind words to
demonstrate empathy and understanding will assist counselling process .
During counselling the pharmacist should avoid asking questions in a
direct or embarrassing way show excessive curiosity discuss the
patient’s personal problems, pass moral judgements, interrupt when
patient is speaking.

 COUNSELLING CONTENT:
It is considered as the heart of counselling session. During this step the
pharmacist explains the patient about their medications and treatment
regimen. Lifestyle changes such as diet or exercise can also be
discussed.
1. Name and strength of medication
2. How it works or why it is prescribed
3. How to take medication
4. Expected duration of treatment
5. Expected benefits of treatment
6. Possible adverse effects
7. Advise on correct dosage
8. Possible dietary or medication interactions
9. Minimum duration required to show therapeutic benefit

 CLOSING THE SESSION:

Before closing it is essential to check the patients understanding. This
can be assessed by feedback questions, such as Can you remember what
this medication is for? Etc., it is advisable to finish session by asking the
patient Do you have any questions? Before closure summaries the main
points in a logical order.

 COUNSELLING AIDS:

Patient information leaflets produced by drug manufacturers for their

products are known as Consumer product information or Consumer
medicine information. PILs are written information leaflets in simple
language about the patient’s illness and its treatment, including
medications and relevant lifestyle changes. Pharmacists can develop
useful PILs using their knowledge of therapeutics and the local
language. PILs are written in English, the Flesch Reading Ease. The
ideal PIL should have a readability score of 70-80

 CONCLUSION:
Patient counselling is an essential component of clinical pharmacy
practice in hospitals and in community pharmacy settings. Patient
counselling enhances the patients understanding of their illness and its
treatment, and may improve adherence and therapeutic outcome.

 REFERENCE:
 A Textbook of Clinical Pharmacy Practice by G. Parthasarathi; 2nd
Edition; Chapter No: 06; Page no:60-67
 A Textbook of Hospital and Clinical Pharmacy Practice by
Balasubramanian; 2nd Edition; Chapter No: 39; Page no:346-351