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Patient Counseling

M. Immanuel Jebastine M.Pharm.,


Asst. Professor,
Vinayaka Missions College of Pharmacy,
Salem - 636008

Patient counseling
Patient counseling may be defined as
providing medication information orally or in
written form to the patients or their
representative or providing proper directions
of use, advice on side effects, storage, diet
and life style modifications. It involves a oneto-one interaction between a pharmacist and
a patient and/or a care giver. It is interactive
in nature. The effective counseling should
encompass all the parameters to make the
patient/party understand his/her disease,
medications and life style modification
required

Contents of patient counseling


Name and description of the medication,
the dosage form, route of administration, duration of
therapy, special directions and precautions for
preparation, administration and use of the prescribed
drugs by the patient, common side effects or adverse
effects
or
interactions
and
therapeutic
contraindications that may be encountered, including
their avoidance, and the action required if they occur,
techniques of self monitoring of drug therapy, proper
storage, prescription refill information, action to be
taken in case of missed dose.

Techniques of counseling
Several techniques can be
adopted for effective counseling. Some
of them include providing written
information to the patient and the use
of audiovisual materials. The use of
various compliance aids include
labeling, medication calendars, drug
reminder chart and providing special
medication containers and caps can
also be adopted.

Stage I:
Medication information transfer, during
which there is a monologue by the
pharmacist providing basic, brief
information about the safe and proper
use of medicine.

Stage II:
Medication information exchange,
during which the pharmacist answers
questions and provides detailed
information adapted to the patients
situation.

Stage III:
Medication education, during which the
pharmacist provides comprehensive
information regarding the proper use of
medicines in a collaborative, interactive
learning experience.

Stage IV:
Medication counseling, during which
the pharmacist and patient have a
detailed discussion intending to give
the patient guidance that enhances
problem-solving skills and assists with
proper management of medical
conditions and effective use of
medication.

Communication skills in patient


counseling
Communication is the exchange of
information, ideas, thoughts and feelings. It
involves not just the spoken words, but also
what is conveyed through inflexion, vocal
quality, facial expression, body posture and
other behavioral processes. Effective
communication with patients depends greatly
on the degree of empathy demonstrated in
the course of conversation. Pharmacist
should use proper verbal and non-verbal
communication skills during the counseling
session.

Studies repeatedly show that effective patient


counseling can significantly reduce patient nonadherence, treatment failure, and wasted health
resources. To be good communicators, pharmacist
must be attuned to the types of questions asked, the
manners in which questions are asked, Studies
repeatedly show that effective patient counseling can
significantly reduce patient non-adherence,
treatment failure, and wasted health resources. To
be good communicators, pharmacist must be
attuned to the types of questions asked, the
manners in which questions are asked, and the
avoidance of repetition

The counseling pharmacist should be


well dressed so that the patient feels
the pharmacist is a professional. The
nature of the counseling should be
tailored to the patient population. A
good counselor is one who listens to
the patient carefully and shares the
problems intimately so that the patient
expresses the emotions underlying the
disease.

During counseling pharmacist should be


totally involved in the counseling and should
not be half minded. Even attending a
telephone call while counseling may affect
the quality of counseling. An effective
counseling will end up with several questions
being asked by the patient. Throughout the
counseling process, the pharmacist should
avoid jargons and slang expressions.

The Patient Counseling for Every


Disease is Depend on Three Category
1. Based on Disease Profile
2. Based on Drug Profile
3. Based on Lifestyle Modification

Patient Counseling For Hypertension


Based on Disease Profile
1. Educate the patient about the disease
severity, the importance of adherence to
therapy, and the consequences of
uncontrolled hypertension.
2. The patient needs to be informed about
what they are, what actions to take to
relieve minor side effects, and what to do
about intolerable or dangerous side effects.

Based on Drug Profile


1. Diuretics: Monitor for muscle weakness, confusion, dizziness.Diuretics
should be taking with food or milk to prevent GI upset and the dosage
should not interrupt sleep due to urination.
2. Beta Blockers: Monitor for hypotension, dizziness, headache, and
bradycardia. Explain the need for dose tapering before stopping the
drug.
3. ACE Inhibitors: Advise to take them 1 hour before meals and monitor
for hypotension, dizziness, cough, taste disturbances and rash.
4. Calcium Channel Blockers: Monitor for swollen gums, chest pain,
swollen joints (with nifedipine), constipation, dizziness, and lightheadedness.
5. Alpha Blockers: Monitor for hypotension.

Based on Lifestyle Modification


1. Maintain a healthy body weight
2. Engage in Regular Aerobic Physical Activity
such as Brisk Walking at least 30 minutes per
day, 5-7 days a week.
3. Consume a diet rich in fruits, vegetables, and
low-fat dairy products with a reduced content of
saturated fat.
4. Restrict Dietary Sodium Intake (2.4 gm sodium
or 6 gm sodium chloride).
5. Smoking Cessation and Alcohol Abstinence.

Patient Counseling for


CONGESTIVE HEART FAILURE
Based on Disease Profile
1. Providing information regarding the
severity of the disease.
2. Counsel the patient of what to do in
the case of Emergency.
3. Educate the patient regarding
possibility of nocturnal dreams, CNS
problems, hypotension, dizziness,
headache, and bradycardia.

Based on Drug Profile


1. Advised to take ACE inhibitors 1 hour before
meals.
2. Diuretics should be taking with food or milk
to prevent GI upset and the dosage should
not interrupt sleep due to urination.
3. Digoxin should not be discontinued during
therapy
4. Avoid over the counter drugs(Antacids, cold,
allergy products & diet drugs)
5. Explain the need for dose tapering before
stopping the drug.

Based on Lifestyle Modification


1. Maintain a healthy body weight.
2. Regular physical activity (e.g. brisk
walking) at least 30 minutes per day.
3. Restrict Dietary Sodium Intake and
adopt a diet rich in fruits and
vegetables.
4. Smoking Cessation and Alcohol
Abstinence.

Patient Counseling for


ISCHEMIC HEART DISEASE
Based on Disease Profile
1. Patients should be encouraged if they
experience chest pain that is more
than an angina, to call for an
Ambulance.
2. Patients also need up-to-date advice
when faced with difficult choices
regarding medical treatment,
angiographic procedures or surgery.

Based on Drug Profile


1. Statins: Educate the patient to take these drugs after food. It is advisable to
take these medications during night (except for atorvastatin). Ask the patient
to report to the doctor if any signs of muscle pain appear and not to worry in
the case of urine discoloration.
2. Nitrates: Sublingual administration, sublingual tablets should not be chewed
or crushed, use of transdermal patches, do not stand up immediately while
using this medication.Monitor for bluish colored lips, fingernails or palms.
3. Fibrates: Take with or immediately after food to lessen stomach upset.
Monitor for blood in urine, chest pain, and shortness of breath, stomach pain.
4. Anion Exchange Resins: This medicine should never be taken in dry form.
Mix the medicine with beverage or drinks.
5. Nicotinic Acid Derivatives: Do not crush, break or chew the extended
release medication. Monitor for darkening of urine, loss of appetite, severe
stomach pain, and yellow eyes.

Based on Lifestyle Modification


1. Regular physical activity (e.g., brisk
walking) at least 30 minutes per day,
5-7 days a week.
2. Eliminate Trans Fat Food like fried,
oily food or baked food.
3. Restricted Dietary Sodium Intake.
4. Smoking Cessation and Alcohol
Abstinence.

Patient Counseling for ASTHMA


Based on Disease Profile
1. Providing information regarding the site and
severity of the disease based on Pulmonary
Function Test results.
2. The patient should be able to monitor
symptoms, peak flow measurements, drug
usuage and knowing how to deal with
fluctuations in severity of asthma.
3. Counselling should lead to increase patient
confidence in the ability to self manage to
asthma, decrease hospital admission rates.

Based on Drug Profile


1. Provide information regarding the action of each of the
medicines they use.
2. The appropriate choice of inhalation devices should be
made and the patient should be educated to use them
correctly.
3. An individualized self management plan should be
developed for each patient.
4. Specific counselling on drugs used to relieve symptoms,
drugs used to prevent the asthma attacks and drugs
which are given only as a reserve treatment for severe
attacks.
5. A self-management plan would also include details of
when to increase the dose of inhaled steroid, when to
take oral corticosteroids and when to use a nebulizer.

Inhalation Technique Counselling for


Dry Powder Inhalers (DPI):
Hold inhaler upright or level.
Take a rotacap capsule from its container. Insert the rotacap
transparent end first, into the raised square hole of the
rotahaler.
Load inhaler with one dose. Press the rotacap firmly such that
the top end of rota cap is level within the top of the hole.
Holding the mouth piece firmly with one hand, rotate the base.
Exhale gently as much as comfortable.
Place mouthpiece in mouth and close lips around it. Inhale
slowly, forcefully and deeply through inhaler and releases a
dose.
Removes inhaler and hold breathe for at least for 5sec then
breathe out slowly, if a second dose is prescribed, wait for 1min
before repeating the above steps, rinse mouth and replace dust
cap.

Inhalation Technique Counselling for


Metered Dose Inhalers (MDI):
Remove dust cap, shake inhaler well and hold
inhaler upright or level.
Load inhaler with one dose, exhale gently as
much as comfortable, place mouthpiece in
mouth and close lips around it.
Inhale slowly, forcefully and deeply through
inhaler and release a dose.
Remove inhaler and hold breathe for at least for
5sec then breathe out slowly, if a second dose
is prescribed, wait for 1min before repeating the
above steps.
Rinse, gargle the mouth and replace the cap.

Based on Lifestyle Modification


1. Avoid environment that may be a reason for the Asthma
attack and use protectants according to the nature like
Umbrella, Rain Coat, Sweater, Cap etc.
2. Take food at proper timings and must be rich in protein.
3. Perform exercises like walking and yoga.
4. Avoid any kind of Emotional Stress, Mental Tension,
Anxiety or Excitement which may trigger Asthma attacks.
5. Explain the importance of Smoking Cessation and
technique for it.
6. Sleep only 2 hrs after any meal.

Patient Counseling for COPD


Based on Disease Profile
1. Explain the patient about the site,
severity and progressiveness of the
disease.
2. Inform about the emergency
management in the case of
Exacerbation.

Based on Drug Profile


1. Use of Inhaled Therapy: The incorrect use
of any inhaler will lead sub therapeutic
dosing.
2. Home Nebulizer Therapy: Patients are
prescribed nebulizer therapy for use at
home should be counselled appropriately.
3. Domiciliary Oxygen Therapy: Portable
oxygen cylinders can be used to increase
exercise tolerance during walking.

Based on Lifestyle Modification


1. Pulmonary Rehabilitation: Advice and support on stopping
smoking, nutritional assessment aerobic exercise training to
increase capacity and endurance for exercise, breathing
retraining.
2. Smoking Cessation: Members of the health care team can
educate smokers about the dangers and actively encourage
and motivate those who want to give up.
3. Take food at proper timings and must be rich in protein.
4. Perform exercises like walking and yoga.
5. Avoid any kind of Emotional Stress, Mental Tension, Anxiety or
Excitement which may trigger Asthma attacks.
6. Sleep only 2 hrs after any meal.
7. Monitor PFT bi- annually and visit the doctor on exact review
dates.

Patient Counseling for


Diabetes Mellitus
Based on Disease Profile
1. The severity of the lifelong disease, its
progression and complications like
Neuropathy, Nephropathy and Retinopathy.
2. The signs and symptoms of the disease.
3. Futher complications which includes
Ketoacidosis and other Infections.
4. Hyperglycemia and Hypoglycemia - Signs
and Symptoms and Treatment.

Based on Drug Profile


DRUGS

ADMINISTRATION
TIME

DOSING
SCHEDULE

POSSIBLE SIDE
EFFECTS

COMMENTS

Glibenclamide

Taken with meals or


15- 30 mins before
food

Usually taken in 1 2
doses

Hypoglycemia,
Obesity

Interacts with Oral


Anticoagulant Action

Glimiperide

Taken with meals

Usually taken in single


dose

Hypoglycemia

Interacts with Oral


Anticoagulant Action

Glicazide

Taken with meals

Usually taken in 1 2
doses

Hypoglycemia

Interacts with Oral


Anticoagulant Action

Glipizide

Taken with meals

Usually taken in 1 2
doses

Hypoglycemia

Interacts with Oral


Anticoagulant Action

Metformin

Taken during or
immediately after a
meal to minimize GI
effects

GI Disturbances

Should be stopped
before Surgery or any
Radiological
Procedures using
Contrast Media

Usually taken in 1 3
doses

DRUGS

ADMINISTRATION
TIME

Acarbose

Swallow whole with


liquid before meal or
chew with first
mouthfuls of meal

Repaglinide

Pioglitazone

DOSING
SCHEDULE

POSSIBLE SIDE
EFFECTS

COMMENTS

Usually taken in 1 3
doses

GI Disturbances

Should be stopped
before Surgery or any
Radiological
Procedures using
Contrast Media

Taken with meals

Usually taken 3 times


a day

Hypoglycemia

Taken with meals

Usually taken in single


dose

Hypoglycemia

Insulin
STEPS

COUNSELLING TIPS

Draw air into the Insulin syringe corresponding to the amount to be taken and inject into vial.

Drawing of Insulin from

Rotate the vial in the palm.

the Vial

Invert the vial, draw up Insulin vertically from eye level, inject excess Insulin back into the vial

and pull out the needle.


Best sites for self injection are front and outer thighs and abdomen.

Clean injection site with spirit, insert the needle at 45 degrees angle into subcutaneous tissue.

Inject Insulin slowly.

Insulin preparations should be taken 30 mins. Before food.

Site of self Injection

Technique of Injections

Time of Administration

STEPS

Storage of Insulin

COUNSELLING TIPS

Insulin should be stored at 2- 80C.

If there is no refrigerator then place Insulin in a glass of water.

It is also adviced to carry Thermostat Bags which retains the stability of the preparations.

Patient should be monitored for Allergic Reactions (Bovine or Porcine preparation).

Hypoglycemia.

Insulin Pen has several advantages (easy to carry, less pain, and accurate dose

ADR

Specialized Devices in
Administering Insulin

administration).

Suitable patients should be isolated and adviced by the pharmacist.

Based on Lifestyle Modifications


1. Exercise benefits and effect on blood glucose
control.
2. Dietary control is the mainstay of treatment in type 2
diabetes and an integral part in type-1 diabetes.
3. Diabetes patient should limit their sugar intake.
4. Since there is an increased risk of death from
coronary artery disease in diabetics, it is wise to
restrict saturated fats and to substitute them with
unsaturated fats.

5. Dietary fiber has two useful properties. Firstly it is


physically bulky and increases satiety. Secondly,
fiber delays the digestion and absorption of complex
carbohydrates, thereby minimizing hyperglycemia.
6. Home Blood Glucose Testing Technique and
Interpretation.
7. Foot Care.
8. Cardiovascular risk factors Smoking,
Hypertension, Obesity and Hyperlipidaemia.
9. Regular Medical and Ophthalmologic Examinations.

Patient Counseling for


OSTEOPOROSIS
Based on Disease Profile
1. Inform patient about the severity and
complication of the disease.
2. Educate the patient that as age
increases the Disease gets worsened.

Based on Drug Profile


1. Take the recommended amount of
Calcium and Vitamin D everyday.
2. Sedatives should be discontinued or
switched to short acting agents.
3. Diuretics should be given during day.
4. Orthostatic Blood Pressure problems
should be resolved.

Based on Lifestyle Modification


1. Perform Weight Bearing Exercises like Brisk Walking,
Jogging, Dancing and Aerobic Exercises on regular
basis.
2. Smoking Cessation and Alcohol Abstinance.
3. Avoid Caffeinated Beverages which increases Calcium
excretion.
4. Counsel the patient to monitor a Bone Mineral Density
(BMD) if patient is above 65 years, on Long Term
Steroid Treatment and who have gone through
menopause and have experienced a fracture.
5. Dietary Calcium Intake and Vitamin D must be
increased.

Patient Counseling For


TUBERCULOSIS
Based on Disease Profile
1. Providing information regarding the
severity of the disease.
2. Cover the mouth with separate
Handkerchief while coughing or
sneezing.
3. Inform the patient about isolation
mainly from children and elderly
people to avoid easy spread of the
disease.

Based on Drug Profile


1. Teaching the patient about the importance
of continuing the drugs even after improving
disease conditions.
2. Dont miss any dose and strictly adhere to
the drug regimen.
3. Teach the importance of Vitamin
Supplementation to the patient.
4. Inform the patient about body fluids
discoloration and Itching while taking these
drugs is nothing to worry about.

Based on Lifestyle Modification


1. Diet should be rich in Raw Fruits and
Vegetables
2. Avoid Caffeinated Beverages and Fried Food.
3. Alcohol Abstinence and Smoking Cessation.
4. Avoid Stress, Mental Tension and Anxiety.
5. Monitor Liver Function Tests while taking AntiTB Drugs.
6. Perform Exercise and Yoga.

Patient Counseling for


MENINGITIS
Based on Disease Profile
1. Begin Education during first Admission.
2. Provide Information to patient regarding the Sverity
and Complication of Disease.
3. Educate the patient about various symptoms of the
Disease.
4. Teach Signs of Dehydration, Signs of inadequate
PO Intake.
5. Notice any kind of Behavioural Changes and
Siezure Activity.
6. Review who to contact for problems and reasons to
call physician.

Based on Drug Profile


1. Preventive Antibiotics are prescribed
in people who are in close contact with
the patient.
2. Oral Fluids are always the preferred
source of Hydration.
3. Use medicine to treat fever and
headache.

Based on Lifestyle Modification


1. Educate Families about Personnel
Hygiene and Good Hand Washing.
2. If patient has Nausea and Vomitting start
with Clear Liquid Diet and advance as
Tolerated to Regular Diet for Age.
3. Discourage sharing of Drinking and
Eating Utensils.
4. Offer Plenty of Fluids.

Patient Counseling for UTI


Based on Disease Profile
1. Provide Information to the Patient
Regarding the cause and Severity of
the Disease.
2. Patient should be informed to review
the Physician if symptoms still persist.
3. Inform the patient about the various
symptoms to report if the Infection
Flares up.

Based on Drug Profile


1. The patient should take full course of
antibiotic even if he or she feels better.
2. Inform patient to take drugs only for
the prescribed time period.
3. Inform patient to avoid any OTC
Drugs.

Based on Lifestyle Modification


1. Various behavioral factors, such as voiding after
intercourse, direction of toilet paper use after
bowel movements, type of menstrual protection
used, and method of contraception, have all
been investigated to assess their impact on the
frequency of UTI.
2. Maintain Personnel Hygiene; use Water to clean
the infected area and not soap.
3. Women with a recurrent UTI should be
encouraged to use a method of birth control.

4. Urination every 2 hours, taking the time to


empty the bladder completely, also helps to
prevent UTI.
5. Foods that irritate the bladder include tea
coffee, alcohol, cola, chocolate, and spicy
foods should be avoided.
6. Encourage the patient to Drink Extra Fluids
to help clear the infection.
7. Educate the patient how to collect
Midstream Urine for Routine Urine Check
Up.

Patient Counseling for


RHEUMATIOD ARTHRITIS
Based on Disease Profile
1. Inform the Patient about the Severity
and Complications of the Disease.
2. Advice the patient to inform about the
medications they are taking and the
presence of any Renal Problem.

Based on Drug Profile


1. NSAID preparation should be taken with
or after food and patients should be
warned of potential adverse effects and
what to do if these occur.
2. Patients must be warned not to
supplement their prescribed NSAIDS with
purchased ibuprofen or aspirin and should
be careful of consuming additional
Hidden paracetamol.

3. Alopecia is likely to occur but it is


reversible and encourage adequate fluid
intake to prevent hemorrhagic cystitis and
to facilitate uric acid excretion with
cyclophosphamide.
4. Encourage compliance with therapy and
follow up visits.
5. Explain to the Patient about the possible
Side- Effects of drugs and to report if they
occur.

Based on Lifestyle Modification


1. Avoid foods containing Furocoumarin such as Carrots,
Celery, Figs and Mustard.
2. Avoid Milk, Meat and Processed Foods which may
exacerbate the Disease.
3. Diet must be Low in Fat, Saturated Fats and
Cholesterol.
4. Protect Skin for 8 hours after oral administration due to
Photoreaction.
5. Monitor Blood and Liver Function Tests regularly due to
certain Medication Toxicity.
6. Swimming and other Motion Exercises are
recommended.

Patient Counseling For Gout


Based on Disease Profile
1. Patient should be advised about
factors that may contribute to
hyperuricaemia, such as fasting,
obesity and alcohol excess.
2. Advice the patient to inform about the
medications they are taking and the
presence of any Renal Problem.

Based on Drug Profile


1. Should avoid aspirin and instead use
paracetamol for analgesia.
2. Patient receiving Allopurinol should
continue single daily dose, warned of
potential side effects and told to report any
adverse skin reactions.
3. Patients on Corticosteroids should be
informed to report any Acidity Problems,
Delayed Healing, Bone or Muscle
Problems, and Night Sweats.

Based on Lifestyle Modification


1. Renal function test should be monitored
frequently.
2. Patient taking Uricosuric Agents should
be with Good Fluid Intake to reduce the
risk of Renal Calculus Formation.
3. A diet free of purine is advisable to keep
uric acid levels within the normal range.

4. Reduce the foods like Caffeinated


Beverages, Fats and Oils, Miscellaneous
(Cinnamon, Clove, Cardamom, Cumin
seeds, Chilly, Pepper, All Spicy Foods,
Sugar, Vinegar, Custard, Popcorns, and
Salt).
5. Diet includes foods like Cereals,
Vegetables, Fruits, Low Fat Milk, and Egg.
6. Avoid Grapefruit and Grapefruit Juice as it
decreases the activity of the Uricosuric
Agents.

Patient Counseling For


ACUTE RENAL FAILURE
Based on Disease Profile
1. Patient should be informed about the Severity
and Complication of the Disease.
2. Educate patient about the Risk Factors which
could worsen the disease like Diabetes Mellitus,
Hypertension, Family History, and Age- related
risk.
3. Inform patient about the symptoms of the disease
getting Worsened like High Blood Pressure,
Blood in Urine, and Pain in Lower Back at about
the Waistline, Swelling especially in the Arms,
and Frequent Urination at Night, Nausea and
Vomiting.

Based on Drug Profile


1. Thiazide diuretic should be taken in
the morning to prevent nocturia.
2. Drug should be taken with food to
minimize gastric irritation.
3. Take Vitamins and Mineral
Supplements which are
recommended.

Based on Lifestyle Modification


1. Maintain the Ideal Body Weight, weigh each day in
the morning and inform the dietitian in case of
losing or gaining of too much body weight.
2. Add potassium-rich food in the Diet like Banana,
Spinach and other Green Leafy Vegetables.
3. Sun screens should be used to protect from
sunlight.
4. Do not need to limit the amount of fluids in the
earlier stages of kidney disease.
5. Take the right amount of the protein as instructed.
6. Reduce Dietary Sodium Intake.

Patient Counseling For


PSORIASIS
Based on Disease Profile
1. Provide complete information to the
patient regarding the severity of the
disease.
2. Provide the patient with information
booklets

Based on Drug Profile


1. Explain the patient about the importance
of adhering to the Medication for better
treatment.
2. Inform patient to apply Moisturizer,
Creams, and Ointments regularly.
3. Monitor Blood and Liver Function Tests
regularly due to certain Medication
Toxicity.

Based on Lifestyle Modification


Avoid any kind of Stress or Worries which triggers
Psoriasis.
Wake up a little early in the morning drink 2
glasses of warm water then sit cross legged on the
floor and do deep breathing and meditate.
Closely monitor climatic changes and adjust
accordingly especially in the travelling and always
try to limit Travelling.
Breathe Fresh Air and Sleep Well.
Educate patient about the possible Photo
Therapies.