PATIENT COUNSELLING. definition and steps pptx

PC is the exchange of information between HP and patient

1. PATIENT COUNSELLING

2. What is Patient Counselling? Patient counseling refers to the process of providing information, advice and assistance to help patients use their medications appropriately. The information and advice is given by the pharmacist directly to the patient or to the patient’s representative, and may also include information about the patient’s illness or recommended lifestyle changes.

3. The information is usually given verbally, but may be supplemented with written material. During counseling, the pharmacist should assess the patient’s understanding about his or her illness and the treatment, and provide individualized advice and information which will assist the patient to take their medications in the most safe and effective manner.

4. To provide accurate advice and information, the pharmacist should be familiar with the pathophysiology and therapeutics of the patient’s disease. Good communication skills are required to gain the patient’s confidence and to motivate the patient to adhere to the recommended regimen.

5. Effective patient counselling aims Better patient understanding of their illness and the role of medication in its treatment Improved medication adherence More effective drug treatment Reduced incidence of medication errors, adverse effects and unnecessary healthcare costs Improved quality of life of the patients Better coping strategies for medication-related adverse effects Improved professional rapport between the patient and pharmacist

6. Communication Skills for Effective Counselling Language : When speaking to patients, use simple language and avoid unnecessary medical terminology. Tone : During counseling, the tone of our voice has a great impact on patient understanding. Changes in the level and range of pitch convey information about the feelings and attitudes of the person speaking.

7. Volume : Many people speak with wide variations in volume, depending on the situation, and where and to whom they are speaking. Ideally, counselling should be conducted in a quiet, private setting where it is unnecessary to raise one’s voice. Speed : The clarity of our communication depends on our rate of speech. Patients may be reluctant to interact with a pharmacist who speaks quickly because they may feel the pharmacist is too busy. This may happen if the pharmacist is nervous or is uncertain about the information being given. In contrast, a person who speaks too slowly may lose the interest of the listener.

8. Non-verbal communication Proximity : This refers to the distance that people maintain between themselves during the counselling process. This space has been classified into four zones: intimate (45 cm or less), personal (45 cm to 1.2 m), social (1.2–3.6 m) and public (>3.6 m). Generally, counsellors and healthcare professionals use intimate or personal proximities.

9. Eye contact : The amount that people look at one another during conversation varies depending on whether they are speaking or listening. Listeners look at the speaker more often and for longer periods of time. Facial expression : These can be used during counselling to demonstrate empathy towards the patient. Head movements such as nodding, hand gestures and body posture also can be used to advantage.

10. Qualities of a good counselor Be a good listener Be flexible Be empathetic Be non-judgemental Be tolerant Communicate confidently

11. Steps of Patient Counselling Preparing for the session Opening the session Counselling content Closing the section

12. Preparing for the session The success of counselling depends on the knowledge and skill of the counsellor . The pharmacist should know as much as possible about the patient and his/her treatment details . In the hospital setting, this may be accomplished by referring to the patient’s case notes. In the community pharmacy setting, sources of information include the patient and their prescription, and in some cases, a record of previous dispensing for the patient.

13. Another issue worth considering is the mental and physical state of the patient. If the patient is in a hurry, in pain or is not communicative, it is very difficult to counsel the patient effectively. In such situations, the aims of counselling may need to be modified, or with the patient’s agreement, the session may be postponed to a later date.

14. Opening the session The pharmacist should introduce him or herself to the patient and greet them by name. If help is required in pronouncing the name, ask colleagues or the patient directly. It is best to use titles such as Ms , Mrs and Mr and then switch over to the first name. The pharmacist should identify the purpose of the session very clearly.

15. For example, ‘Hello, Mr Sreenivas ! I am Vinod , your pharmacist. I would like to tell you about your medication. Do you have a few minutes to spend with me?’. Patients who visit community pharmacies are often in a hurry to go home with the medication, and this type of introduction mentally prepares the patient to spend some time with the pharmacist.

16. Next, the pharmacist gathers information from the patient about their understanding of the disease they are suffering from, drug treatment and use of alternative medications such as ayurvedic medications or home remedies. Other information which may be relevant includes previous drug allergies, past medical history and personal habits such as chewing pan masala, smoking cigarettes and consuming alcohol

17. Using open-ended questions is a useful technique for gaining the confidence of the patient, and the answers allow the pharmacist to assess the patient’s information needs. For example, ‘What did your doctor tell you about your illness?’, ‘What do you know about your disease ? Patients may be disturbed and distressed due to their illness, and this may reduce their ability to receive and understand information from both the doctor and the pharmacist. In these situations, a few kind words to demonstrate empathy and understanding will assist the counselling process.

18. Counselling content The counselling content is considered to be the heart of the counselling session. During this step, the pharmacist explains to the patient about his or her medications and treatment regimen. Lifestyle changes such as diet or exercise may also be discussed.

19. Name and strength of the medication The reason why it has been prescribed (if known), or how it works How to take the medication (how much and how often) Expected duration of treatment Expected benefits of treatment Possible adverse effects Possible medication or dietary interactions Advice on correct storage Minimum duration required to show therapeutic benefit What to do if a dose is missed Special monitoring requirements, for example, blood tests Arrangements for obtaining further supplies

20. Closing the session Before closing the session, it is essential to check the patient’s understanding. This can be assessed by feedback questions, such as ‘Can you remember what this medication is for?’ or ‘For how long should you take this medication?’. During the discussion, some of the patient’s information needs may have been cleared, but the patient may have new questions or doubts.

21. It is therefore advisable to finish the session by asking the patient ‘Do you have any questions?’. Before final closure and if time permits, summarise the main points in a logical order. If appropriate, the pharmacist can supply their telephone number to encourage the patient to make contact if they need further advice or information.

22. Barriers to Patient Counselling

23. Patient-based barriers : In India, many patients are unaware that pharmacists may provide counselling and generally ask their prescriber about medication use. Gender and language differences may also inhibit patients from asking the pharmacist about medication use information.

24. Provider-based barriers : Many pharmacists lack the confidence to counsel patients due to lack of knowledge and counselling skills. A heavy patient load for prescription filling is also an important barrier in many practice situations. System-based barriers : In India, counselling is not a mandatory legal requirement and officially pharmacists are not entitled to charge for dispensing or for the information provided to patients. These factors act as regulatory and financial disincentives to providing a counselling service. Lack of privacy in many busy community and hospital pharmacies can also be a problem.