Objectives:

1.Uderstand why Pharmacists need to

become skilled in patient counseling
2.Able to describe and define patient
counseling
3.Describe how people feel about being ill
and using medication
4. Demonstrate the use of techniques
involved in patient counseling
5. Identify and deal with special conditions

Chapter 1.
The Role of Patient Counseling in Pharmacy.
I.-Patient Counseling to improve patient
Care
II.- Providing professional services
through patient Counseling
III.- Patient Counseling and
Pharmaceutical Care
IV.- Challenges in patient Counseling

Adherence/ Non adherence

Medication error
Adverse drug Reaction
Side effects

Patient Counseling to improve patient Care

What is Adherence?
The extent to which a person s behaviortaking
medication, following a diet, or making healthy
lifestyle changescorresponds with agreed upon
recommendations from a health- care
provider (World Health Organization, 2003)
Medication adherencethe extent to which
patients take medications as prescribed by their
providers and agreed upon in the treatment plan
Medication Adherence /Patient Compliance

Medication Adherence: The patients

conformance with the providers
recommendation with respect to timing ,
dosage, And frequency of medication-taking
during the prescribed length of time (CDPCCenter for disease control and prevention)

Compliance: Patients passive following of

providers orders

DHHS-Department of Health and Human

Services ( US)Causes of non compliance/ non adherence:
1.Lack of information about the drug
2.impatience and lack of education.
3.High cost of health care
4.Fear
5.Denial
6.unrealistic expectations

Non-adherence
FACTS:

non compliance

(common non-adherence errors include):

Forgetting to take your medicine.
Taking the right medication at the wrong time. Taking
the incorrect medication.
Taking the incorrect dosage (too few or too many pills).
Discontinuing taking your medication prematurely.
Not filling or refilling a prescription.
Double dosing- taking two pills to make up for a
skipped one.
Combining your medication with an inappropriate food
or beverage.

"A medication error is any preventable event

that may cause or lead to inappropriate
medication use or patient harm while the
medication is in the control of the health care
professional, patient, or consumer. Such events
may be related to professional practice, health
care products, procedures, and systems,
including prescribing, order communication,
product labeling, packaging, and
nomenclature, compounding, dispensing,
distribution, administration, education,
monitoring, and use." The National
Coordinating Council for Medication Error
Reporting and Prevention (NCC MERP)

Causes of medication error.

Failed communication
Lack of patient education
Incorrect drug administration
Dispensing processes and drug
distribution
Knowledge level of pharmacist and
patient.

What is an adverse drug event (ADE)?

An adverse drug event is an injury resulting
from the use of a drug. Under this definition,
the term ADE
includes harm caused by the drug (adverse
drug reactions and overdoses) and harm from
the use of the drug
(including dose reductions and discontinuations
of drug therapy).
1
Adverse Drug Events may results from
medication errors but most do not.

An adverse drug reaction is a response to a

drug which is noxious and unintended and
which occurs at doses normally used in man
for prophylaxis, diagnosis, or therapy of
disease or for the modification of physiologic
function. Note that there is a causal link
between a drug and an adverse drug
reaction.

In sum, an adverse drug reaction is harm

directly caused by the drug at normal doses,
during normal use.

A side effect is usually regarded as an

undesirable secondary effect which occurs
in addition to the desired therapeutic effect
of a drug or medication. Side effects may
vary for each individual depending on the
person's disease state, age, weight, gender,
ethnicity and general health.

Side effects can occur when commencing,

decreasing/increasing dosages, or ending a
drug or medication regimen. Side effects
may also lead to non-compliance with
prescribed treatment. When side effects of
a drug or medication are severe, the dosage
may be adjusted or a second medication
may be prescribed. Lifestyle or dietary
changes may also help to minimize side
effects.

VA Center for Medication Safety

And
VHA Pharmacy Benefits Management
Strategic
Healthcare Group and the Medical Advisory
Panel
November 2006

Medication
errors are more
common
than adverse
drug events,
but result in
harm less than
1% of the time.
About
25% of adverse
drug events
are due to
medication
errors.

Counseling to enhance
medication adherence

1.Motivational interviewing

Motivational interviewing is an alternative form

of communication that combines a patientcentered yet directive approach to discussing
medication adherence and health behavior
change.
Motivational interviewing focuses on the
patients own motivation for change and
adherence to treatment and identifies
reasons why a patient may be resistant to
making a change.

2.Understanding of disease, medications

Patients should be educated about the benefits of
treatment and what may happen if medications are
not taken as prescribed
Counseling should be tailored to address a patients
specific diseases
Use the teach back method to assess whether
patients understand what you told them. This
method incorporates several steps such as
explaining a new concept, assessing the patients
recall and understanding, clarifying the explanation
as needed, and reassessing comprehension until
the patient has a clear understanding of the
information

3.Simplifying regimen, patient reminders

Talk to patients to determine the best time for them

to take medications and find out if regimens with
multiple daily doses may be problematic.
Converting regimens to once-daily dosing options
and reducing pill burdens by using combination
tablets may be beneficial interventions for
improving adherence.
4.Addressing cost issues
Talk to patients about insurance coverage, access to
assistance programs, and the availability of
cheaper options if cost barriers influence
adherence.

Benefits of Patient counseling to

improve patient care:

Reduces errors in using medication

Reduces non compliance
Reduces adverse drug reaction
Increases satisfaction with care
Assists self care
Can provide referral for assistance with non-drugrelated situations
Reduces health care costs to individual.
Government and society
Is an integral part of providing patient centered
pharmaceutical care.

II Providing Professional pharmacy

services through patient counseling:
Provides compliance with pharmacy legislation,
standards and regulations
Afford legal protection, since pharmacist may
be held accountable for injury resulting from
insufficient information provided to the
patient.
Maintains professional status as part of primary
care and health care team
Increases job satisfaction.

Two supports needed for patient counseling;

Legal support= regulations released officially
by the government to enforce a required
service.
Professional support- Pharmacist as a
professional should see the services of
providing pharmaceutical care as an
essential duty that they should always
perform.
Omnibus Budget Reconciliation Act of 1990
(OBRA 90) of Federal Government

1.

2.

3.

3 important issues to carry professional support

:
Patients are in most case completely reliant on
health care professionals for information about
their medication. This dependence implies
their right to receive information about the
safe use of their medication.
The government has the right to provide
effective and safe use of medication to
improve quality of care and reduce cost of
drugs.
The professionals right to survive and gain the
respect of patients and health care providers.

III- Patient Counseling and

Pharmaceutical Care

Pharmaceutical care is the direct,

responsible provision of medication-related
care for the purpose of achieving definite
outcomes that improve a patients quality of
life. Wikipedia

Pharmaceutical care is a philosophy of

practice in which the patient is the primary
beneficiary of the pharmacists actions.
Pharmaceutical care focuses the
attitudes, behaviors, commitments,
concerns, ethics, functions, knowledge,
responsibilities and skills of the pharmacist
on the provision of drug therapy with the
goal of achieving definite therapeutic
outcomes toward patient health and quality
of life.1 (Essential Medicines and Health Products
Information Portal A World Health Organization resource )

The scope of pharmacy and the functions of

pharmacists
With the development of specific and potent synthetic drugs,
the emphasis of the pharmacists responsibility has moved
substantially towards the utilization of scientific knowledge in
the proper use of modern medicines and the protection of the
public against dangers that are inherent in their use.
Pharmacists are employed in regulatory control and drug
management, community pharmacy, hospital pharmacy, the
pharmaceutical industry, academic activities, training of other
health workers, and research. In all these fields, their aim is to
ensure optimum drug therapy, both by contributing to the
preparation, supply and control of medicines and associated
products, and by providing information and advice to those
who prescribe or use pharmaceutical products.
(Essential Medicines and Health Products Information Portal A
World Health Organization resource )

IV-Challenges in patient counseling:

Only few pharmacist are giving correct
counseling.
Counseling is given in less than a minute.