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PATIENT COUNSELING

MARIAN MILAN B. VICTORIANO, RPh. RN. MAN


OBJECTIVES
1. Describe patient counseling.
2. Explain the pharmacy-client therapeutic relationship.
3. Enumerate and explain the bridges and barriers in the therapeutic
relationship.

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TOPICS
A. Basic Concepts / Principles in Therapeutic Counseling
• Understanding the Counseling Perspective
• The Pharmacy-Client Therapeutic Relationship
• Bridges and Barriers in the Therapeutic Relationship

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UNDERSTANDING THE COUNSELING PERSPECTIVE

INTEGRAL TO
PROVIDING PATIENT
COMPETITIVE COUNSELING
AND IMPROVES
PROFESSIONAL PATIENT CARE
SERVICES

http://www.nsad.org.nz/NSADStory

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PATIENT COUNSELING TO IMPROVE PATIENT CARE

• Reduces errors in using medication


• Reduces noncompliance
• Reduces adverse drug reactions
• Improves outcomes
• Increases satisfaction with care
• Assists with self-care

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PATIENT COUNSELING TO IMPROVE PATIENT CARE

• Can provide referral for assistance with non-drug related


situations (e.g., family planning and emotional problems)
• Reduces health care costs to individual, government and
society
• Is an integral part of providing patient-centered
pharmaceutical care

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PROVIDING PROFESSIONAL PHARMACY SERVICES
THROUGH PATIENT COUNSELING
• Provide compliance with pharmacy legislations, standards,
and regulations
• Affords legal protection
• Maintains professional status as part of the primary care and
health care team
• Increases job satisfaction and reduce stress

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PROVIDING PROFESSIONAL PHARMACY SERVICES
THROUGH PATIENT COUNSELING
• Is an added service to meet patient demand and aid in
market competition
• Increases revenue through payment for counseling services
and reduces loss resulting from unfilled or un-refilled
prescriptions
• Is an integral part of providing pharmaceutical care
REQUIRES PATIENT-PHARMACIST INTERACTION ESTABLISH PHARMACIST-PATIENT RELATIONSHIP
STEP IN THE PHARMACEUTICAL CARE PROCESS THAT

COLLECT AND INTERPRET PATIENT INFORMATION


LIST AND RANK DRUG-RELATED PROBLEMS
DETERMINE DESIRED PHARMACOTHERAPEUTIC GOALS
DETERMINE FEASIBLE ALTERNATIVES
SELECT AND INDIVIDUALIZE THE MOST APPROPRIATE
TREATMENT REGIMEN
DESIGN A DRUG-MONITORING PLAN
IMPLEMENT DECISIONS ABOUT DRUG USE
DESIGN A MONITORING PLAN TO ACHIEVE DESIRED
THERAPEUTIC GOALS
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THE PHARMACY-CLIENT THERAPEUTIC RELATIONSHIP

A constructive
pharmacist-patient EFFECTIVE
relationship is COMMUNICATION
essential to sound (verbal & non-
health care practice verbal)
and the optimal
well-being of the
patient. CHARACTERISTICS
 Mutual Trust
 Respect

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BARRIERS IN THE THERAPEUTIC RELATIONSHIP:

ANXIETY

STEREOTYPING

VIOLATION OF PERSONAL SPACE OR CONFIDENTIALITY

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BARRIERS Strategies to reduce
Barriers in the Therapeutic Relationship:
Anxiety A vague, persistent feeling of impending Active listening Honesty Explanations Acting in
danger Occurs when a threat (real or calm, unhurried manner Speaking clearly, firmly
Setting reasonable limits Encourage clients to
imagined) to one’s self-concept is explore reasons for anxiety Using play therapy
perceived with dolls, puppets, games Drawing for young
clients Using therapeutic touch, warm baths,
back rub Recreational activities like music, card
games, reading Teaching breathing and
relaxation techniques Using guided imagery
Stereotyping is attributing characteristics to a group of people as Acceptance of the other person needs
though all persons in identified group possess them unconditional acceptance without judgement
can be according to ethnic origin, culture, religion,
social class, occupation, age, health issues, etc.
are learned during childhood and reinforced by life
experiences
Violation of personal Sharing too much info about yourself or about your Advocate for client’s personal space and
other clients can make your client unclear about communicate client’s preferences to members
space or his/her role in your relationship of health team
confidentiality A client might feel that if you are talking about other
clients, you might also be talking about him or her
Personal space is defined by culture, past experiences
and current circumstances
Person who loses control over personal space, may
experience loss of individuality, self-identity and self-
esteem
Direct eye contact
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BRIDGES IN THE THERAPEUTIC RELATIONSHIP:

CARING EMPOWERMENT TRUST

EMPATHY MUTUALITY CONFIDENTIALITY

TREAT CLIENT IN
RESPECTING
JUST AND
VERACITY CLIENT’S
BENEFICIAL
AUTONOMY
MANNER
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BRIDGES IN THE THERAPEUTIC RELATIONSHIP:

BRIDGES
Caring Caring actions include: communication, positive regard for patient, support and physical intervention

Caring is act of giving freely and willingly of oneself to another thru compassion, warmth, concern and interest

Caring is visible when we explain to patient about condition in terms that patient can understand

To care for client is to make him involved in health care rather than just do for client

Empowerment Assist people to develop knowledge, skills and resources they need to: take primary role in their care, and to take control over their
decisions about their lives
Trust Development of a sense of trust, a sense of feeling safe

Trust provides a non-threatening climate in which client feels comfortable to reveal own needs

Maintain confidentiality
Empathy Recognize that client’s feelings belong to client, not to you
Mutuality both parties are committed to enhancing client’s well-being
Upon termination of mutual relationship, both parties experience a sense of accomplishment
Confidentiality No divulging of information
Any confidential information that does not contribute to management of client care should not be included in record
Data about client or client’s condition are not shared with client’s family or health professionals who are not involved in the client’s
care without client’s consent
Veracity (truthfulness)
Respecting client’s autonomy
Treating client in just & beneficent manner

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TOPICS
• Defining Patient Counseling
• Understanding Patient’s Needs, Wishes and Preferences
• Medication Counseling Basics
• Preparing for the Counseling Encounter
• The Counseling Process
• Nonprescription Drug Counseling

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PATIENT COUNSELING

• Is pharmacists talking with patients about the medications


they are intended to take in order to educate them about
medication-related issues and to help them get the most
benefit from their medications. Thus, there are both helping
and educational goals of patient counseling in pharmacy.

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UNDERSTANDING PATIENTS’ NEEDS, WISHES, AND
PREFERENCES

Each counseling situation, the pharmacist needs to


determine the particular needs, wishes, and preferences of
each individual patient’s health.
The specific details of what needs to be done to accomplish
those goals for each individual patient need to be
determined.

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MEDICATION COUNSELING BASICS
• Pharmacist-Patient encounter should consist of an
exchange of information, feelings, beliefs, values, and ideas
between the patient and RPh
• It should not consist of one-sided lecture by the RPh

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PREPARING FOR THE COUNSELING
ENCOUNTER
• Review patient’s medication record
• Note any disabilities or language barriers
• Review the condition being treated
• Privacy

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5 PHASES OF COUNSELING SESSION
1. Opening discussion
2. Discussion to gather information and identify needs
3. Discussion to resolve problems and develop a
pharmaceutical care plan
4. Discussion to provide information and educate
5. Closing discussion

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OPENING DISCUSSION
• Introduction
• Explain purpose of counseling

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DISCUSSION TO GATHER INFORMATION
AND IDENTIFY NEEDS
NEW PATIENT REFILL Rx/FOLLOW-UP MONITORING
 Gather patient information  Adherence problems
 Conduct medication management consult  Details of medication use
 Evidence of side effects
RETURNING PATIENT  Effectiveness of treatment
 Confirm patient information  Potential problems
 Confirm medication use information
SELF-CARE
NEW Rx  Description and duration of symptoms
 Knowledge about purpose, medication, regimen and  Has physician been consulted
condition, and treatment goal  What treatment has been used previously?
 Potential problems

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DISCUSSION TO RESOLVE PROBLEMS AND
DEVELOP A PHARMACEUTICAL CARE PLAN
• Discuss real or potential problems
• Agree on alternatives
• Implement plan
• Discuss outcomes and monitoring

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FOLLOW-UP QUESTIONS:
• What times of day do you plan to take the medication?
• How can you schedule the medication around your daily
activities to help you remember to take the medication
regularly?
• How will you plan for doses that need to be taken during
the day while you are at work?
• How can you store your medication while you are
traveling?

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DISCUSSION TO PROVIDE INFORMATION
AND EDUCATE
NEW PRESCRIPTION  NO MEDICATION RECOMMENDED
 Provide information on condition and medication  Refer to physician
 Adherence and self-monitoring  Suggest non-drug treatment
 Refill and follow-up monitoring  Provide information needed
 Reassurance
NONPRESCRIPTION DRUG  Pharmacist follow-up
MEDICATION RECOMMENDED
 Provide information on condition and medication REFILL Rx/FOLLOW-UP MONITORING
 Future treatment  Clarify drug or condition information
 Reassurance  Self-monitoring information
 Self-monitoring  Refer to physician prn
 Sid effects and precautions  Resolve side effects
 Non-drug treatment  Reassure
 Pharmacist follow-up

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CLOSING DISCUSSION
• Recap
• Get feedback
• Encourage questions
• Confirm monitoring follow-up

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REFERENCES

Gennaro, A.R. (2013). Remington: The Science and Practice of Pharmacy. (22nd ed.). London : Pharmaceutical
Press

Rantucci, M.J. (2007). Pharmacists Talking with Patients: A Guide to Patient Counseling. Philadelphia: Lippincott
William & Wilkins.

Boh, L.E. & Young, L.Y. (2001). Pharmacy Practice Manual: A Guide to the Clinical Experience. (2nd ed.). Philadelphia:
Lippincott Williams & Wilkins.

Department of Health. 1994. Hospital Pharmacy Management Manual. Philippines.

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