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Guidelines of Patient Counseling

Guidelines of Patient Counseling

Guidelines for Patient Counseling

By: Rasha Abdelsalam Elshenawy

Important Outcomes, Benefits and Guidelines of Patient Counseling

What are the Guidelines for Patient Counseling?

Medicines play an important role in medical care. It is important to learn how to be a patient counselor.
In addition, treatment effectiveness depends on the medication’s efficacy and patient adherence to the therapeutic regimen.
It is essential to learn how to be an effective patient counseling pharmacist.
Adherence to medications is essential to achieving the best possible pharmacotherapy outcomes.
Besides, the Non-adherence to medications results in higher healthcare costs, more extended hospitalisation, and increased morbidity and mortality.
Moreover, Patient counselling refers to providing vital information, advice and assistance.
It’s done to help the patients with their medications and ensure they take them properly.
This also includes essential information about the patient’s illness and lifestyle.
A patient is advised on whether medications should be taken with or without food, at bedtime or in the morning, with water, juice or milk.
Finally, all this information results in the proper use of medications and the best therapeutic action.

Importance of Knowing the Guidelines of Patient Counseling:

The Annals of Internal Medicine published a study examining patient compliance and its impact on the economy.
Of the medications that were filled, nearly half were taken inappropriately.
The consequences of not taking medications as prescribed are costly and can be dangerous
This leads to poor disease management, hospitalisations, and even deaths.
Emergency room visits and hospital stays increased as well.
In addition, this was mainly due to an inability to afford medication.
These numbers only underline how noncompliance can lead to increased costs in the healthcare system.
Moreover, even more, shocking is that nearly a quarter-million people in the USA die each year due to a lack of medication adherence.
These costs can all be avoided if the proper counselling and patient education take place
Besides, that is a responsibility that mainly lies with the pharmacist.
The New England Healthcare Institute (NEHI) predicts that approximately 290 billion dollars could be saved yearly with proper adherence and medication education.
Another risk of inappropriate patient counselling is Adverse drug reactions (ADRs).
Adverse drug reactions (ADRs) are a leading cause of morbidity and mortality
It accounts for up to 30% of US hospital admissions and costs approximately $170 billion annually.

Guidelines for Patient Counseling in Elderly People

Elderly patients are at the highest risk of experiencing ADRs, many of which are preventable.
Actual, perceived, or even fear of ADRs increases the likelihood of medication non-adherence
This leads to suboptimal treatment efficacy and adds to the disease burden.
Actual ADRs can result from medication pharmacology.
Whereas psychological factors influence perceived or fear of ADRs.
In addition, these factors include predetermined medication views, lack of belief in treatment necessity, the anticipation of ADRs, conditioning based on past experiences, and misattributing symptoms as ADRs.
Besides, the Clinician and pharmacist’s awareness of these factors will help to reduce the risk for ADRs and optimise management
In addition, this will ultimately allow patients to benefit from the intended treatment.
Finally, the American Society of Health-Systems Pharmacists (ASHP) provides guidelines and emphasises the role of pharmacists in comprehensive ADR management.

Here are some tips for Guidelines for Patient Counseling

Risk Minimisation

Understand patient views about medication therapy.
In addition, educate about the benefits of treatment.
Inform patients about potential ADRs and management strategies should any occur.
Ensure an updated and accurate medication list.
Utilise decision support software to help prevent ADRs.
Start with low doses and frequencies and slowly titrate as tolerated.
Initiate less-potent agents, agents with direct mechanisms of action, or alternatives with lower adverse event incidence.
Avoid or reduce the use of interacting medications.
Prescribe dosage forms with minimal systemic exposure (e.g. creams, patches).

Recognition, Detection

Be familiar with known ADRs of the medication and the patient’s pre-existing symptoms.
Evaluate new symptoms as possible ADRs, looking into health conditions, labs, or other factors which may explain the symptoms.
Besides, consider the temporal relationship between medication initiation and symptom onset.
Challenge concepts like stopping the medication to see if the symptom subsides in the absence of the medication and restarting to see if symptoms return.
Utilise lab tests for more evidence to identify an ADR.
Apply probability tools7-9 such as the Naranjo Adverse Drug Reaction Probability Scale or 4Ts for heparin-induced thrombocytopenia.10
Express empathy and maintain a trusting relationship with the patient.
In addition, reduce dosing or discontinue the offending medication.
Switch to another agent or dosage form less likely to cause ADRs.
Moreover, treat side effects when necessary (beware of prescribing cascades).
Document the ADR in the patient’s medical record.

Difference between patient counselling and patient education:

On the one hand, patient education includes presenting:

Basic medical information
Side effects and interactions
Storage, how to store drugs properly.

On the other hand, patient counselling includes:

Clinical information, including the disease state
Lifestyle modification
Monitoring and follow-up of the drug

The content of an education and counselling session

Should include the information listed below,

The medication’s trade name
Besides the medication’s use and expected benefits and action.
Moreover, the medication expected onset of action and what to do if the action does not occur.
In addition to the medication’s route, dosage form, dosage, and administration schedule
Directions for preparing and using, or administering the medication.
Action to be taken in case of a missed dose.
Precautions to be observed during the medication’s use or administration
Potential common and severe adverse effects
Techniques for self-monitoring of pharmacotherapy.
Potential drug-drug (including nonprescription), drug-food, and drug-disease interactions or contraindications.
The medication’s relationships to radiologic and laboratory procedures (e.g., the timing of doses and potential interferences with the interpretation of results).
Prescription refill authorisations and the process for obtaining refills.
Instructions for 24-hour access to a pharmacist.
In addition to the Proper storage of the medication.
Proper disposal of contaminated or discontinued medications and used administration devices.
Any other information unique to an individual patient or medication

Steps and Guidelines of the Patient Counseling process

It varies according to the health system’s policies and procedures, environment, and practice setting.

Generally, the following steps are appropriate for patients receiving new medications:

1. Establish caring relationships with patients.

Introduce yourself as a pharmacist.
Explain the purpose and expected length of the
Sessions.
Obtain the patient’s agreement to participate.
Determine the patient’s primary spoken language.

2. Assess the patient’s knowledge about their health problems and medications.

Asses their capability to use the medications appropriately and attitude toward the health problems and medications.
Ask open-ended questions about each medication’s purpose and what the patient expects
Ask the patient to describe or show how they will use the medication.

3. Provide information orally and use visual aids or demonstrations.

Open the medication containers to show patients the oral solids’ colours, sizes, shapes, and markings.
For oral liquids and injectables, show patients the dosage marks on measuring devices.
Demonstrate the assembly and administration of nasal and oral inhaler devices.
As a supplement to face-to-face oral communication, provide written handouts to help the patient recall the information.
In addition to gathering data and assessing the problems if a patient is experiencing problems with their medications.
Then, adjust the pharmacotherapeutic regimens according to protocols or notify the prescribers.

4. Verify patients’ knowledge and understanding of medication use.

Ask patients to describe or show how they will use their medications and identify their effects.
Observe patients’ medication-use capability, accuracy, and attitudes toward following their regimens.

Role of the pharmacist:

The pharmacy profession is changing within the healthcare system.
It’s making pharmaceutical care one of its primary responsibilities.
In addition, Pharmaceutical care does not adhere to how pharmacists have traditionally practised.
Instead, it requires the pharmacist to work with the patient and other healthcare providers to promote health.
Pharmaceutical care requires that pharmacists prevent and resolve drug-related problems.
Also for optimising drug therapy while involving the patient throughout the process.
For this reason, pharmaceutical care does not end when the patient leaves the pharmacy
It involves assessment, monitoring, documenting care and progress, and follow-up care.
As current and future pharmacists, we should understand the influence of our care through a communicative relationship with the patient.
Finally, as pharmacists, one of the essential counselling points for all patients is the importance of medication adherence.

Skills for patient counselling:

Various skills are vital to successful pharmacist-patient interaction during patient counselling sessions.

The following are ten features of effective patient counselling:

1. Establish Trust

Pharmacists are among the most accessible and trusted healthcare professionals.
When initiating a patient counselling session, pharmacists should introduce themselves with a brief, friendly greeting.
This makes patients comfortable to ask questions about their medication therapies and health conditions.
Pharmacists who demonstrate a genuine interest in patient care are more likely to encourage dialogue.

2. Communicate Verbally

Pharmacists can encourage dialogue by asking questions.
They should assess what the patient already knows about their chosen therapy.
That is to tailor the counselling to meet their needs.
Ask patients what their physician has told them about the selected therapy.
Also, ask them about the condition they are being treated for.

3. Communicate Nonverbally

In addition to verbal communication, pharmacists must be aware of nonverbal communication.
This is such as maintaining eye contact with the patient to demonstrate an interest in the information the patient is relaying.
Pharmacists also should be aware of other nonverbal clues, such as facial expressions and tone of voice, when interacting with patients.

4. Listen

Listening to the patient’s concerns, questions, and needs is essential.
Listening skills can be categorised into four classes: passive listening, acknowledgement responses, encouragement, and active listening.
Passive listening occurs when the pharmacist enables the patient to communicate without interruption.
An acknowledgement response such as nodding occurs during passive listening.
This alerts the patient that the pharmacist is indeed listening.
Pharmacists can also use encouragement strategies such as “yes” or “go on.”
Active listening involves two-way interactions between the patient and the pharmacist.
It should consistently be implemented after passive listening.

5. Ask Questions

Pharmacists should state why asking specific questions does not offend the patient.
Asking open-ended questions enables pharmacists to gather more information that may lead to other questions.
This question provides valuable information to the pharmacist to further assess the patient.

6. Remain Clinically Objective

pharmacists mustn’t allow personal beliefs to affect their ability to counsel a patient effectively.
Pharmacists should make every possible effort to be nonjudgmental and impartial
This is to focus on patient care and maintain a professional demeanour.

7. Show Empathy and Encouragement

When a pharmacist displays empathy and encouragement, a patient may feel more comfortable.
And so patient discusses their medical condition and medication use.
This enables the pharmacist to obtain pertinent information on the patient’s needs and concerns.
Emphasizing to patients the importance of adherence to medication regimens promote positive therapeutic outcomes.
Also, motivate patients to take an active role in managing their health.
Pharmacists also should remind patients to call the pharmacy with any concerns about their medications.

8. Provide Privacy and Confidentiality

Ensuring complete privacy helps patients feel comfortable discussing personal medical issues.
Today, many pharmacies have particular counselling areas to address privacy issues.
When counselling, pharmacists can reassure patients of privacy.
This is by monitoring voice levels and counselling patients away from the dispensing area when possible.

9. Tailor Counseling to Meet Patient Needs

The ability to tailor patient counselling to meet individual needs is critical.
Pharmacists should be aware of patients with disabilities and be prepared to treat them with respect and understanding.
Techniques should be tailored to accommodate the needs of each patient.
This is done via verbal counselling, visual aids, and demonstrations when warranted.
When medication therapy involves specific administration techniques, pharmacists should demonstrate them.
This is to ensure that patients are adequately trained.

10. Motivate Patients

Effective counselling not only provides patients with the pertinent information they need.
It also motivates them to adhere to their medication regimens.
Pharmacists can motivate patients by discussing the benefits of medication adherence, offering support, and explaining the pros and cons of treatment.
For example, when counselling a patient with diabetes, in addition to teaching the patient about medications,
In addition, the pharmacist can stress the importance of maintaining tight glycemic control.
This is to decrease or prevent the complications associated with diabetes.
Pharmacists can also make suggestions, such as using medication reminder containers to facilitate patient adherence.
Information should always be relayed positively.
Additionally, pharmacists should look continually for ways to inspire patients to learn more about their treatment plans.

A simple approach to help you as a community pharmacist in patient counselling

A simple approach is developed that helps keep you focused while providing a patient counselling session.

Moreover, we all need tools to help us remember to cover all vital medication counselling and counseling patients.

The approach goes as follows:

Dosage: Discuss the dose of the medication, how it should be taken, and any specific dosage timing issues.
Results: What should the patient expect while taking this medication?

How is the drug working in the body, and how can the patient tell if the medication is working?

Underlying Issues: Present potential issues that the patient needs to be aware of when taking the medication
General information: Assess the patient’s understanding of the above information.

Many patients rely on pharmacists for medication information and education.

Therefore, we must stay current on understanding the critical counselling topics for every medication we dispense.

In addition, we must maintain our skills as patient educators to convey such information to our patients appropriately.

Patient counseling resources:

Here are eight credible, user-friendly health sites you can feel good about recommending to your patients:

Conclusion:

In general, patient counselling has three main objectives: assessing the patient understanding of the therapy.

In addition to including proper use and adverse effects of the medication, improving patient adherence, and motivating the patient to take an active role in health management.

Studies have shown that patient counselling can improve patient care in various ways^:

Reducing medication errors
Increasing patients? understanding and management of their medical condition
Moreover, Minimising the incidence of adverse drug reactions and drug-drug interactions
Improving patient outcomes and satisfaction with care

Pharmacists should understand the influence of the care they provide and work on their skills to improve it.

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